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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4188.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":8116.46,"maximum":8116.46,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13236.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":5580.81,"maximum":5580.81,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5580.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":4454.68,"maximum":4454.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4454.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":7761.88,"maximum":7761.88,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7761.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":7366.37,"maximum":7366.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7366.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":4143.55,"maximum":4143.55,"setting":"inpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4143.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":4547.31,"maximum":13087.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11001.54,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13087.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4547.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":16854.88,"maximum":16854.88,"setting":"inpatient","payers_information":[{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16854.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":9918.53,"maximum":9918.53,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9918.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"minimum":22586.58,"maximum":22586.58,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22586.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":12464.49,"maximum":12464.49,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12464.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":4449.93,"maximum":4449.93,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4449.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":12464.92,"maximum":12464.92,"setting":"inpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12464.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":13155.61,"maximum":13155.61,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13155.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":6052.08,"maximum":6623.45,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6052.08,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6623.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":3262.40,"maximum":10256.48,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3262.40,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10256.48,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7208.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":16734.01,"maximum":16734.01,"setting":"inpatient","payers_information":[{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16734.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":6272.64,"maximum":6272.64,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6272.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":4492.12,"maximum":4492.12,"setting":"inpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4492.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":5141.08,"maximum":10366.5,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5141.08,"methodology":"other"},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9166.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8967.94,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10339.90,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10366.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":3770.91,"maximum":5873.61,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3770.91,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5873.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":5330.12,"maximum":5330.12,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5330.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":8510.93,"maximum":8510.93,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8510.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":2608.51,"maximum":11673.59,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11673.59,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2608.51,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4211.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":9604.57,"maximum":9604.57,"setting":"inpatient","payers_information":[{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9604.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":5669.79,"maximum":5669.79,"setting":"inpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5669.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":10778.10,"maximum":23099.4,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18572.73,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10778.10,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23099.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"minimum":21266.16,"maximum":21266.16,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21266.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":10859.15,"maximum":26665.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26665.14,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15105.77,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10859.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":13316.9,"maximum":18686.81,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13316.9,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18686.81,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18686.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":6059.49,"maximum":16014.62,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10107.51,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9029.52,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6059.49,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16014.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":9814.14,"maximum":9814.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9814.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":10821.88,"maximum":10821.88,"setting":"inpatient","payers_information":[{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10821.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1769.6,"maximum":3969.50,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2688.20,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1769.6,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2515.32,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1997.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3144.14,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3969.50,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":12227.41,"maximum":12227.41,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12227.41,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12227.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":2086.6,"maximum":11865.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8430.26,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6549.75,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7669.84,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8765.74,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8706.07,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2086.6,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9864.74,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11865.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":13233.08,"maximum":13233.08,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13233.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":1483.29,"maximum":9797.2,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1483.29,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9797.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":11194.93,"maximum":11194.93,"setting":"inpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11194.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":8452.58,"maximum":28694.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16236.46,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11532.76,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17427.96,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28366.57,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17396.62,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8452.58,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20093.73,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28694.39,"methodology":"other"},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11451.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":155.01,"maximum":368.45,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.36,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":287.91,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":368.45,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":24.09,"maximum":1709.55,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.41,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":708.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":760.32,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.89,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":458.03,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":385.50,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":570.25,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.09,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1709.55,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":134.09,"maximum":1594.6,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215.29,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1594.6,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1042.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Nap","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1337.47,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":224.46,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":453.27,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":560.00,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":552.25,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.30,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":608.13,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1340.65,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":495.13,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.57,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":949.52,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.09,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":935.5,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1564.16,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":221.63,"maximum":2855.41,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.8,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1407.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1278.8,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Nap","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1403.45,"methodology":"other"},{"payer_name":"Aetna","plan_name":"First Health","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2567.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.03,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":684.46,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.53,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1027.28,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":821.04,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1455.2,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":957.49,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":231.24,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":442.74,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.38,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2855.41,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":353.39,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1726.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":150.0,"maximum":4140.85,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":725.31,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1847.86,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3150.75,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Nap","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1529.94,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2715.78,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":659.24,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1266.96,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1344.56,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1559.09,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1201.17,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1412.71,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1454.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.1,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":748.88,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1095.59,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2611.14,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4140.85,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":641.33,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.0,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1491.5,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":807.9,"methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":661.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":761.09,"maximum":2269.72,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2104.85,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2269.72,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":761.09,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2209.6,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2109.74,"methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2194.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":160.23,"maximum":689.9,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.34,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.37,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.80,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":328.62,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.37,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.23,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":689.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":206.78,"maximum":919.81,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":919.81,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":835.38,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":830.90,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":835.38,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.78,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.56,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":636.79,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":1306.37,"maximum":1306.37,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1306.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"minimum":4595.56,"maximum":4595.56,"setting":"outpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4595.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":1355.15,"maximum":4683.21,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2544.78,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4683.21,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1355.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":255.0,"maximum":1408.84,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.0,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1408.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"minimum":423.5,"maximum":423.5,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":423.5,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":423.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":32.35,"maximum":32.35,"setting":"outpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":1601.37,"maximum":1601.37,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1601.37,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1601.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":1644.25,"maximum":7000.9,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3750.35,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7000.9,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2077.48,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1644.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":747.23,"maximum":747.23,"setting":"outpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":747.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":747.23,"maximum":7053.26,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":860.47,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":747.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1678.62,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1667.83,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5258.1,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2629.04,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1667.83,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1684.88,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1022.38,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7053.26,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":973.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":477.51,"maximum":477.51,"setting":"outpatient","payers_information":[{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":9411.7,"maximum":9411.7,"setting":"outpatient","payers_information":[{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9411.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":235.83,"maximum":369.66,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.83,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":369.66,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":30.00,"maximum":603.58,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.42,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":603.58,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.00,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.92,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.36,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.87,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.92,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.1,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.13,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":396.46,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.03,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":520.56,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":63.69,"maximum":1339.3,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.84,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1339.3,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Nap","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.69,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":253.82,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.22,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.59,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.67,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.99,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.75,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.55,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.59,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.51,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":184.32,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.67,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.35,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":482.9,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.87,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.66,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.0,"methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":178.68,"maximum":2602.99,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.22,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2541.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":940.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2216.49,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.47,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":302.4,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332.43,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":591.33,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":315.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":399.0,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.96,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.76,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":334.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2602.99,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.0,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2541.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":25.0,"maximum":1951.45,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.39,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":448.23,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":626.45,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.09,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1951.45,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.71,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":384.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":54.0,"maximum":3946.2,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.66,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.19,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":721.36,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.62,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":573.03,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.68,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.09,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":510.24,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3946.2,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.06,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":196.35,"maximum":2083.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":208.77,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2083.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":329.47,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":741.75,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":829.1,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":619.76,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":665.77,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":938.22,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.35,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.03,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2032.8,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":329.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":342.2,"maximum":10547.36,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.08,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1456.75,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.6,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1456.75,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10547.36,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":331.13,"maximum":1401.73,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":331.13,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":732.05,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1401.73,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1398.49,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":12.0,"maximum":1577.08,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1577.08,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.59,"methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":55.4,"maximum":55.4,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":235.32,"maximum":1063.18,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.32,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1063.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":78.3,"maximum":213.23,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.3,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":254.80,"maximum":4307.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.97,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":254.80,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":266.14,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4307.85,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":466.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":73.5,"maximum":506.42,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.87,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":103.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.5,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.87,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.3,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":506.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":264.41,"maximum":330.83,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":330.83,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":295.14,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":270.78,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":317.79,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.24,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.69,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.41,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"minimum":426.28,"maximum":5461.0,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.45,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1170.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1552.97,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2003.3,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1420.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1803.3,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2611.26,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":787.44,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5461.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":426.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":6958.8,"maximum":6958.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6958.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":51.69,"maximum":9079.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7804.78,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9079.48,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.43,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6698.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.91,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.61,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.34,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.69,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.27,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":74.18,"maximum":11926.66,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11926.66,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.47,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.45,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129.08,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.35,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":226.56,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.18,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6710.41,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.95,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91.41,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.35,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1740.98,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7452.20,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3968.36,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4642.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":252.49,"maximum":25225.67,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25225.67,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.49,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.02,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2570.75,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12205.13,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5570.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Glucagon hydrochloride","code_information":[{"code":"9042","type":"APC"}],"standard_charges":[{"minimum":2680.22,"maximum":2680.22,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2680.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"minimum":269.69,"maximum":269.69,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":269.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":16.96,"maximum":1800.75,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.68,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16.96,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.22,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.33,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.8,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.06,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.84,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.12,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.68,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.30,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.52,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.32,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.08,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.4,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":986.04,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.32,"methodology":"other"},{"payer_name":"Multiplan","plan_name":"Phcs","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1800.75,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.65,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.35,"methodology":"other"},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":127.04,"maximum":1920.91,"setting":"outpatient","payers_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.04,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1275.0,"methodology":"other"},{"payer_name":"Aetna","plan_name":"Aetna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1038.0,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":432.5,"methodology":"other"},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.04,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1499.42,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1017.03,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1131.04,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1101.78,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":583.98,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1246.04,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1523.96,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576.72,"methodology":"other"},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":286.16,"methodology":"other"},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":915.65,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Cigna Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1920.91,"methodology":"other"},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.7,"methodology":"other"},{"payer_name":"United","plan_name":"United Healthcare Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1020.0,"methodology":"other"},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":334.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":875.06,"maximum":7567.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Geha","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7567.31,"methodology":"other"},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":875.06,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Multiple Outpatient Hospital E/M Encounters on the Same Date","code":"27","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Drug amount discarded/not administered to any patient","code":"JW","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"X-ray taken using computed radiography technology/cassette-based imaging","code":"FY","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]},{"description":"Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","code":"CO","modifier_payer_information":[{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Mcr Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aarp Medicare","plan_name":"Aarp Uhc Medicare Complet","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Nap","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Aetna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"First Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Geha","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mc Epo Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Medicare","plan_name":"Aetna Mcare Ppo Or Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Bcbs Medicare Adv Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok 65 Select","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Blue Option","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Bluelincs H","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Fep Federal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Goodyear","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Native Blue","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Preferred","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Ok Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 2","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Cross Out Of State 3","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Exchange","plan_name":"Blue Cross Hlth Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Out Of State Mcr Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bc Tn Lifepoint Emp","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Medicare","plan_name":"Bcbs Medicare Blue Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Cigna Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Choice Mcr Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana Medicare","plan_name":"Humana Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Webtpa Phcs","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Healthcare Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United","plan_name":"United Hlthcare Indemnity","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Group Mcare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Medicare","plan_name":"Uhc Mcare Swingbed","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare Medicare","plan_name":"Wellcare Mcr Centene","description":"The modified price is presented in the standard charge value."}]}]}