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The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing 88363 Review of A","code_information":[{"code":"968697","type":"CDM"},{"code":"310","type":"RC"},{"code":"88363","type":"CPT"}],"standard_charges":[{"gross_charge":93.01,"discounted_cash":55.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Pathology Billing Pap Smear, Automa","code_information":[{"code":"986083","type":"CDM"},{"code":"311","type":"RC"},{"code":"88148","type":"CPT"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":42.18,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Gyn Cytology with","code_information":[{"code":"986084","type":"CDM"},{"code":"311","type":"RC"},{"code":"88164","type":"CPT"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":29.85,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Gyn Cytology Sure","code_information":[{"code":"986085","type":"CDM"},{"code":"311","type":"RC"},{"code":"88142","type":"CPT"}],"standard_charges":[{"gross_charge":83.28,"discounted_cash":49.97,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Pap Smear, Automa","code_information":[{"code":"986087","type":"CDM"},{"code":"311","type":"RC"},{"code":"88147","type":"CPT"}],"standard_charges":[{"gross_charge":137.35,"discounted_cash":82.41,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Pap Smear, Liquid","code_information":[{"code":"986088","type":"CDM"},{"code":"311","type":"RC"},{"code":"88174","type":"CPT"}],"standard_charges":[{"gross_charge":72.46,"discounted_cash":43.48,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Pap Smear, Liquid","code_information":[{"code":"986089","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"CPT"}],"standard_charges":[{"gross_charge":117.88,"discounted_cash":70.73,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CDSM - NDSC","code_information":[{"code":"98765432","type":"CDM"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Pathology Billing Non-Gyn Cytology","code_information":[{"code":"989011","type":"CDM"},{"code":"311","type":"RC"},{"code":"88160","type":"CPT"}],"standard_charges":[{"gross_charge":153.57,"discounted_cash":92.14,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing FNA Interp and Re","code_information":[{"code":"989021","type":"CDM"},{"code":"311","type":"RC"},{"code":"88173","type":"CPT"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":142.14,"setting":"both","modifiers":"90","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier 90: Reference (Outside) Laboratory"}]},{"description":"Pathology Billing FNA Immediate Rea","code_information":[{"code":"989022","type":"CDM"},{"code":"311","type":"RC"},{"code":"88172","type":"CPT"}],"standard_charges":[{"gross_charge":382.85,"discounted_cash":229.71,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"Pathology Billing Non-Gyn Cytology","code_information":[{"code":"989025","type":"CDM"},{"code":"311","type":"RC"},{"code":"88104","type":"CPT"}],"standard_charges":[{"gross_charge":128.7,"discounted_cash":77.22,"setting":"both","modifiers":"TC","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard | The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SNF Laundry","code_information":[{"code":"990070050","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":49.44,"discounted_cash":29.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Set & Style","code_information":[{"code":"990470061","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":19.57,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Shampoo & Blow Dry","code_information":[{"code":"990470067","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":30.9,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Hair Color","code_information":[{"code":"990700049","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":57.68,"discounted_cash":34.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Shampoo / Set","code_information":[{"code":"990700055","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":30.9,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Haircut","code_information":[{"code":"990700056","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":12.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Permanent w/Haircut","code_information":[{"code":"990700058","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":163.77,"discounted_cash":98.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Shampoo Only","code_information":[{"code":"990700059","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Manicure","code_information":[{"code":"990700060","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Conditioner / Rinse","code_information":[{"code":"990700062","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Facial Hair Trim","code_information":[{"code":"990700064","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Other Ancillary","code_information":[{"code":"990700099","type":"CDM"},{"code":"990","type":"RC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: standard"}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"minimum":1050.0,"maximum":322051.87,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":189105.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":1050.0,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18747.75,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":275453.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":322051.87,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":38970.04,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":268725.01,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65624.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"minimum":62144.26,"maximum":117528.05,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62144.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":65744.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":117528.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"minimum":16051.77,"maximum":1582729.61,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57896.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":207361.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242059.91,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576490.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":121272.36,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1582729.61,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":135015.42,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":128870.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16051.77,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":133443.57,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":302538.04,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":302538.04,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"minimum":68299.83,"maximum":156377.73,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136172.13,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121037.95,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145394.67,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":68299.83,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":156377.73,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":136470.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":106035.52,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":101938.46,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":84273.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"minimum":70240.95,"maximum":70240.95,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":70240.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"minimum":40012.61,"maximum":40012.61,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":40012.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"minimum":16992.29,"maximum":75873.51,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16992.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":75873.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"minimum":72871.44,"maximum":72871.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72871.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"minimum":7841.0,"maximum":32041.81,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":32041.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"minimum":35288.74,"maximum":203926.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203926.32,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38542.15,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52098.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":35288.74,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":55581.00,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":114973.74,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":57384.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":38378.20,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55328.26,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":55279.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"minimum":1747.0,"maximum":108105.33,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45477.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":37123.28,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21417.77,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":37674.22,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":80956.74,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":41784.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1747.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":35908.64,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32897.25,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":108105.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":30843.51,"maximum":739730.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":739730.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43477.33,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":66802.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43498.22,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51541.36,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":45982.15,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":114875.93,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":39360.87,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":114875.93,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":30843.51,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":35245.99,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43342.89,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":42608.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":21220.09,"maximum":28395.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25188.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28222.71,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21220.09,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24019.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":28395.74,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":28345.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"minimum":16033.43,"maximum":28188.58,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16638.2,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22599.73,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16033.43,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28188.58,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16992.28,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":24232.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":31657.47,"maximum":76193.96,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39672.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42104.44,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76193.96,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":72829.14,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":31657.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":21729.56,"maximum":42104.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42104.44,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21729.56,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":34282.47,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32851.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"minimum":11040.12,"maximum":30556.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14137.65,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30556.82,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16003.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11040.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"minimum":13564.21,"maximum":13564.21,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13564.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"minimum":22404.99,"maximum":22531.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22404.99,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":22531.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"minimum":2474.36,"maximum":2474.36,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2474.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":20514.58,"maximum":32543.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28044.16,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":20514.58,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":32543.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":1152.98,"maximum":93191.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93191.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.98,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10930.7,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12494.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":6297.0,"maximum":11670.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6297.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11585.89,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11670.02,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11358.23,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10056.44,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":11636.5,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11612.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":3365.4,"maximum":45001.49,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45001.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3365.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"minimum":8489.73,"maximum":59021.53,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":59021.53,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8489.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"minimum":13537.17,"maximum":17519.2,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13537.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":17519.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"minimum":14801.13,"maximum":14801.13,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14801.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"minimum":21008.87,"maximum":21008.87,"setting":"inpatient","payers_information":[{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":21008.87,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":5015.93,"maximum":30397.69,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11400.27,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":14718.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13332.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":30397.69,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5015.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12453.94,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15018.73,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":15018.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":6759.09,"maximum":11218.97,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11218.97,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6759.09,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11149.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":5033.60,"maximum":24578.13,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13218.79,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":24578.13,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23180.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7303.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5033.60,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16741.88,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":23034.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":5734.16,"maximum":84407.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13949.86,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12545.6,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":10633.33,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13942.86,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13485.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6906.51,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":13787.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":28255.6,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":35700.91,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5734.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5831.63,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":84407.88,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"minimum":14159.75,"maximum":14159.75,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14159.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":4749.71,"maximum":4749.71,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4749.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":7142.42,"maximum":9499.42,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9499.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8354.03,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7142.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7609.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"minimum":7970.62,"maximum":31194.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26480.86,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24881.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":26480.52,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7970.62,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31194.01,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26473.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"minimum":8383.55,"maximum":86301.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17729.16,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8383.55,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":86301.4,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18066.32,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":17712.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"minimum":13389.28,"maximum":14137.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14137.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13389.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":6551.2,"maximum":60068.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7933.43,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26987.34,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":22652.14,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19802.44,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49437.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8163.22,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6551.2,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":19919.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11259.14,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18017.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":11259.12,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":51131.28,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11685.51,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12295.24,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":13472.39,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":20874.36,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25450.69,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19956.16,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18633.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":60068.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":60068.13,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":1299.63,"maximum":48407.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10487.33,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10438.12,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27822.62,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":48407.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":10468.22,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21146.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11150.11,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1424.52,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15620.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8383.55,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1299.63,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10386.45,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10645.02,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8383.54,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9221.89,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26688.14,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":40268.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10536.28,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13532.03,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13532.03,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":10451.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27892.41,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7454.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":3498.46,"maximum":22215.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3498.46,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7365.12,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15542.01,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6189.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8981.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7341.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8383.55,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7462.81,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7486.86,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6753.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7337.13,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":6645.02,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22215.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"minimum":11477.58,"maximum":11477.58,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11477.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":4576.19,"maximum":9176.75,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9176.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4576.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":6521.88,"maximum":63224.95,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7567.86,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6521.88,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":7458.0,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8229.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":63224.95,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8369.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":8627.36,"maximum":12758.8,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12758.8,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9109.2,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8627.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":5396.89,"maximum":71839.4,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10864.42,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11007.65,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":71839.4,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8602.71,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5396.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":5857.28,"maximum":8373.54,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5857.28,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6759.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8373.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":6129.51,"maximum":7753.99,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7730.57,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6129.53,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6129.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7753.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":5021.47,"maximum":9078.52,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8152.25,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":9078.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6129.53,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5021.47,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6742.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":33560.0,"maximum":33560.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33560.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"minimum":6954.14,"maximum":7164.38,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7164.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6954.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"minimum":5601.98,"maximum":10296.26,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5601.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10296.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"minimum":19676.37,"maximum":19676.37,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":19676.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":11994.13,"maximum":554391.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22899.54,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":15326.17,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22798.76,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25629.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":38279.95,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":276717.11,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":23294.82,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11994.13,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":21240.3,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":21493.74,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":22816.84,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23991.68,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":554391.7,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":3741.38,"maximum":216518.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9853.81,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":216518.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13994.78,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24552.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13989.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7717.95,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":61948.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":14270.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3741.38,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7717.94,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13877.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":4508.0,"maximum":160051.43,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":9363.95,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160051.43,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6517.93,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9887.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5395.87,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10054.91,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":26142.77,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7717.94,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94735.3,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9675.8,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":55748.87,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":5098.02,"maximum":22684.38,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10264.86,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":22354.09,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11199.97,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19945.47,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":5098.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16404.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16060.74,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22684.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":3156.0,"maximum":115977.39,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19132.61,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11209.62,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30974.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3156.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":12941.25,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":115977.39,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10264.86,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":11691.27,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7483.46,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4508.0,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":109993.66,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":30186.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":13564.87,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":17428.58,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":35809.62,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5449.4,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6811.79,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":12529.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":5019.81,"maximum":87858.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5019.81,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7525.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6139.10,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":87858.94,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9395.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":40379.81,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6556.90,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":8325.29,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9207.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"minimum":7084.37,"maximum":127103.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9422.21,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7084.38,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":127103.14,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":66830.34,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7084.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"minimum":9803.84,"maximum":63658.19,"setting":"inpatient","payers_information":[{"payer_name":"Shap Health Plan","plan_name":"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":63658.19,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9803.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":2234.48,"maximum":34700.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16101.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8262.12,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18132.18,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34700.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12683.00,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":10851.31,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9806.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18512.42,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15175.65,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2234.48,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":18221.14,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13264.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":1600.0,"maximum":28210.88,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":10829.7,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5991.40,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7225.27,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10910.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9105.08,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19018.58,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8476.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9192.12,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1600.0,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":28210.88,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10687.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":2558.04,"maximum":21940.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":21940.28,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6759.08,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7434.99,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19653.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19653.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2558.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":16146.53,"maximum":31739.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31739.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16146.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"minimum":34855.71,"maximum":203866.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":203866.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":34855.71,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":37616.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"minimum":10924.02,"maximum":33028.29,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":33028.29,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10924.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"minimum":11578.78,"maximum":71639.94,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":71639.94,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11578.78,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":32736.87,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":32736.87,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":4952.00,"maximum":68325.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19653.39,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32678.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9772.32,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9184.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7347.62,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":52865.72,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":17012.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":11945.24,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":54352.18,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4952.00,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":18010.11,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5110.38,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":68325.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":1066.39,"maximum":45277.45,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21677.42,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":45277.45,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":11842.1,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26526.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7155.19,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6390.28,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31756.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5172.16,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":1066.39,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4625.26,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5917.82,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9601.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9560.38,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9374.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"minimum":9109.2,"maximum":12041.84,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9109.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12041.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":4880.39,"maximum":22374.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8846.39,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":22374.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8083.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6490.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5833.26,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4880.39,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5425.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"minimum":4739.26,"maximum":229403.54,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":229403.54,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4739.26,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15392.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"minimum":4739.28,"maximum":4739.28,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4739.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"minimum":39205.0,"maximum":39205.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":39205.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":3400.04,"maximum":8134.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8134.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5798.23,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5268.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3400.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":6510.01,"maximum":6510.01,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6510.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"minimum":10978.0,"maximum":10978.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10978.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":29802.84,"maximum":29802.84,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29802.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":11224.11,"maximum":12790.5,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11224.11,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12790.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"minimum":15692.44,"maximum":15692.44,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15692.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"minimum":8758.94,"maximum":14356.92,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14356.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8758.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"minimum":3131.22,"maximum":23430.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23430.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3131.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":7086.39,"maximum":7086.39,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7086.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":4809.34,"maximum":40375.26,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7056.9,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":7796.12,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11219.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7333.57,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40375.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7999.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4809.34,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5290.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7902.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"minimum":6169.28,"maximum":6169.28,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":6169.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":3977.59,"maximum":3977.59,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3977.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":6847.06,"maximum":8278.72,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8278.72,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6847.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":2846.56,"maximum":14990.42,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5512.49,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":6505.43,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7904.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3495.66,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8032.15,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2846.56,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8523.51,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7715.03,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":14990.42,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"minimum":11363.09,"maximum":111439.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111439.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11363.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14041.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":5502.95,"maximum":5502.96,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5502.96,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5502.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":3977.58,"maximum":5290.18,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5290.18,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3977.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":11363.09,"maximum":11363.09,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11363.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":1168.10,"maximum":58603.71,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15432.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":58603.71,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7318.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5502.96,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5129.12,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1168.10,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":11416.07,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11416.07,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":24726.65,"maximum":144504.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31485.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24726.65,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":46324.51,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32804.69,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":44840.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":42415.21,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":64072.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":34272.08,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":144504.61,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":144504.61,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":4975.49,"maximum":184803.77,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":184803.77,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36851.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4975.49,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":23113.14,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":23399.5,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90507.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":12897.61,"maximum":17911.41,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12897.61,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":17911.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":6167.56,"maximum":21188.55,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18860.48,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6167.56,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8280.94,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":21188.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":5957.46,"maximum":18509.76,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18509.76,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9185.69,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5957.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":12001.39,"maximum":12001.39,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":12001.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":3648.17,"maximum":131899.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3648.17,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47046.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":14916.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18032.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7877.1,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – 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":13427.66,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":14619.8,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9402.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9703.98,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":14360.04,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13270.88,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7290.55,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":13501.16,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":131899.62,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":5501.84,"maximum":22664.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16024.18,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7532.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6351.73,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":22664.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6351.71,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19857.09,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5501.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":2488.16,"maximum":87175.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16135.42,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":76294.5,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":19775.66,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17188.74,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10741.43,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":11593.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16188.11,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10985.07,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11007.83,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2488.16,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9316.24,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16240.8,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":19721.32,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":15339.61,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16209.91,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22232.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22232.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87175.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":2090.15,"maximum":20426.42,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10315.3,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11575.25,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7401.67,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6175.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2090.15,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":20426.42,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10337.94,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":9797.51,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10250.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":1985.7,"maximum":12454.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12454.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1985.7,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":8020.58,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8127.82,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2509.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":8366.39,"maximum":14342.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14342.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10446.41,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8366.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":5367.83,"maximum":46719.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46719.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9732.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11354.02,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8142.3,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5367.83,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9770.18,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":31076.32,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":2977.29,"maximum":91922.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18249.78,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91922.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13487.69,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70522.97,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9587.55,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":81426.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16253.3,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2977.29,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15942.24,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54499.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":4309.11,"maximum":420161.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10935.21,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59863.8,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9302.41,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":9473.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6115.51,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":120034.8,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":420161.91,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11192.8,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28995.08,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4309.11,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":140179.44,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.0,"maximum":45638.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45638.05,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28834.82,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13321.52,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6843.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6115.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6552.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":8202.84,"maximum":65829.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8202.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":15858.48,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":65829.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9416.5,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11009.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":5175.68,"maximum":10342.82,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8202.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10342.82,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6167.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5175.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":6167.56,"maximum":8202.84,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8202.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6167.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":8544.23,"maximum":59345.19,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40563.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12793.22,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12416.07,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8973.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":12584.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9335.41,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":24687.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10160.72,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9335.39,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8544.23,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":12574.19,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12529.48,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":12529.48,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59345.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":4988.74,"maximum":13133.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13133.15,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4988.74,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":9819.89,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11448.61,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7058.36,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11725.77,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7058.35,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7764.19,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":11491.25,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8292.38,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":11419.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":3832.25,"maximum":8969.33,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3832.25,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8969.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5689.13,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5689.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":4616.16,"maximum":31364.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31364.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4616.16,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5800.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":2335.38,"maximum":244196.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13299.28,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":13621.9,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13500.68,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":13662.62,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9904.66,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":10183.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13326.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7724.96,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":244196.89,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":19925.56,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10274.42,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10382.12,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7724.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2335.38,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8497.45,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":13326.8,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":9896.4,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":12350.23,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13328.68,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9591.44,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13924.39,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13608.23,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13608.23,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":43994.88,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":5172.42,"maximum":40225.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18891.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8587.22,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35159.5,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8208.9,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8569.22,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7203.11,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8228.43,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15838.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8592.74,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5415.88,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":40225.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":6378.56,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5172.42,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5957.46,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8670.22,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8565.93,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8493.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":3969.57,"maximum":26540.76,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6241.32,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3969.58,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3969.57,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8976.80,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6686.54,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":26540.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":26540.76,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6943.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":9114.2,"maximum":21950.49,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9704.56,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":21950.49,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15653.09,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18754.84,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9114.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":6901.0,"maximum":9114.21,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9114.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6901.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"minimum":5330.81,"maximum":5330.81,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5330.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":6167.55,"maximum":53049.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53049.06,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17629.28,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":20079.91,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6167.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17637.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":6167.55,"maximum":114645.52,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114645.52,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9302.41,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":10426.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11210.35,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6167.56,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11528.07,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":95572.47,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6167.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11293.89,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":38604.9,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":38604.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":6167.56,"maximum":9302.41,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9302.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6167.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":2076.23,"maximum":52867.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":15752.42,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9972.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45276.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5146.64,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":26410.18,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2076.23,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6456.21,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17755.38,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":9986.5,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":52867.21,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":3378.04,"maximum":27171.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3378.05,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3378.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3777.66,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27171.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":4353.46,"maximum":8732.7,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8732.7,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7941.92,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":4353.46,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5146.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7475.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":6309.22,"maximum":84475.72,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22787.25,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11098.19,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84475.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8344.52,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8959.51,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6309.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":17082.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":36538.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":36538.92,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11412.36,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4139.74,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1632.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4933.44,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7693.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":219378.72,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88587.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219378.72,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71622.16,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":35190.66,"methodology":"other"},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138965.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":104052.21,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12328.09,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":45432.62,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":9199.0,"maximum":174831.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26450.45,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26297.43,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9199.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174831.48,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20015.87,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15153.84,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26895.22,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":108849.98,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12802.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":20754.87,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13873.68,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":81216.38,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":47604.4,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":13563.0,"maximum":67532.72,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13563.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":66391.69,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":67532.72,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":66880.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"minimum":1925.7,"maximum":130117.24,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76247.71,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":85332.85,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1925.7,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":68418.69,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":130117.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":69133.89,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":36921.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":34784.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"minimum":31220.57,"maximum":31220.57,"setting":"inpatient","payers_information":[{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31220.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"minimum":3453.42,"maximum":246907.68,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104958.76,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":70285.21,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":79146.57,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":57853.9,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":246907.68,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":56264.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3453.42,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":82449.83,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":109935.42,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":129008.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"minimum":24795.4,"maximum":122067.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":122067.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":26537.88,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":80308.14,"methodology":"other"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":109121.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":24795.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":25883.88,"maximum":175619.83,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175619.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":34063.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":25883.88,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":47742.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":9498.0,"maximum":47379.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9498.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9960.61,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35295.35,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":47379.49,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":47379.49,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"minimum":38970.06,"maximum":391319.99,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391319.99,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":79146.56,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":38970.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":135430.0,"maximum":135430.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135430.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":42867.04,"maximum":81378.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75540.12,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81378.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":47036.99,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":52036.30,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":45343.50,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":42867.04,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73167.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":3391.52,"maximum":51777.59,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":38864.96,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":51777.59,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3391.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":64650.18,"maximum":64650.18,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":64650.18,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":39873.22,"maximum":39873.22,"setting":"inpatient","payers_information":[{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39873.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"minimum":17439.18,"maximum":47949.93,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47949.93,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24090.68,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":28143.32,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":30326.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":17439.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"minimum":12852.70,"maximum":27913.56,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":19909.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18113.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12852.70,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":19924.62,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":27913.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"minimum":13529.09,"maximum":13529.09,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":13529.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":1246.98,"maximum":53842.74,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":20482.2,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":34851.01,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":33851.57,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1246.98,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":26561.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33199.29,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":31494.93,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":53842.74,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":20588.45,"maximum":60429.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22245.89,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21117.48,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":20588.45,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":22220.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22695.49,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":60429.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":22321.49,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":42560.52,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":13958.57,"maximum":54429.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22401.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":27854.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13958.57,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":18049.2,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":54429.74,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18448.07,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":17959.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17928.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"minimum":25569.01,"maximum":25569.01,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":25569.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"minimum":25216.0,"maximum":25216.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25216.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":21737.95,"maximum":60374.7,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23517.32,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":23325.96,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":60374.7,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":21737.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":16012.46,"maximum":30984.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30984.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16012.46,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":20780.46,"maximum":35852.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35852.54,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33541.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25711.40,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21103.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":31591.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":20780.46,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":24188.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":12242.39,"maximum":25511.47,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25158.79,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12242.39,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17559.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":17559.79,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":21265.08,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":25511.47,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13527.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":14686.72,"maximum":17510.86,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14686.72,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":17510.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":24060.04,"maximum":80579.55,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":34063.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":24060.04,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":80579.55,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":13627.46,"maximum":297805.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":297805.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13627.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15322.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16911.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"minimum":27616.27,"maximum":27616.27,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":27616.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"minimum":37725.67,"maximum":37725.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37725.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"minimum":5121.35,"maximum":19340.18,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13706.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5121.35,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19340.18,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"minimum":1535.47,"maximum":1535.47,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":1535.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":1250.1,"maximum":275720.53,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1250.1,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":24168.74,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":275720.53,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":41289.92,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":162204.65,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":162204.65,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"minimum":1575.0,"maximum":67495.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56489.4,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57743.15,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58048.16,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":67495.06,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1575.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"minimum":3837.95,"maximum":47943.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47943.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3837.95,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47922.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"minimum":3336.49,"maximum":64477.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64477.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3336.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":38896.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37992.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30455.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38896.09,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1632.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2098.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":4139.66,"maximum":281778.27,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87072.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148066.68,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43515.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":49583.87,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":25402.86,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":61718.72,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":41933.5,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":281778.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4139.66,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49610.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":3399.58,"maximum":67815.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67815.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24593.66,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18208.57,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":31697.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3399.58,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":23214.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":2053.93,"maximum":25402.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2053.93,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":24677.32,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":25402.84,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24619.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"minimum":1956.73,"maximum":24637.15,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24637.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1956.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"minimum":1512.17,"maximum":55925.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9498.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30369.55,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7056.89,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7591.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30466.24,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28023.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18196.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1512.17,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30458.25,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":30446.02,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55925.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"minimum":66684.25,"maximum":80862.24,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":66684.25,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":80862.24,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"minimum":36561.68,"maximum":58759.35,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":58759.35,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":36561.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"minimum":32134.99,"maximum":45400.96,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":32134.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":45400.96,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43199.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"minimum":46773.9,"maximum":46773.9,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":46773.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"minimum":1603.49,"maximum":37430.6,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37430.6,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":28143.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1603.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":2112.06,"maximum":39709.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15991.31,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13616.68,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16455.23,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7964.71,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":16445.23,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11833.76,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16711.88,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4021.51,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16788.14,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7349.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2112.06,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8743.02,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16445.23,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16193.26,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":39709.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":39709.5,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":5506.46,"maximum":72300.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":40950.7,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14550.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7316.82,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":25646.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9742.88,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":25285.13,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5506.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6139.55,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8084.57,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9568.53,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8035.02,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":72300.16,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":72300.16,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":6795.11,"maximum":30426.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7692.79,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10410.65,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8519.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7072.37,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12943.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7845.7,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":7349.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6795.11,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":11692.52,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10036.88,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7666.56,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30426.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":9022.0,"maximum":278999.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21743.82,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":278999.95,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19819.06,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9022.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18804.48,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":18917.99,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19760.6,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19445.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"minimum":2016.51,"maximum":2016.51,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2016.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":7856.0,"maximum":50992.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21604.73,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21910.5,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27126.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20011.88,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11415.14,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":7856.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":50992.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9237.71,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13423.82,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":21944.02,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21910.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":30713.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12802.05,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11225.67,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13563.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":17721.9,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8528.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11930.86,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30713.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10629.57,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":29514.16,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":16399.37,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11405.88,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":8580.72,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":6657.12,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10629.56,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":23566.24,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13258.86,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11124.57,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":11137.54,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":17654.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":6587.35,"maximum":42924.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13198.37,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13180.57,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15682.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":13173.64,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13180.57,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27401.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7747.57,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":12112.17,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13262.11,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8285.46,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":21478.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7302.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":34956.16,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7769.35,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6587.35,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":13204.09,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":11938.56,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9936.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13176.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":15471.06,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15471.06,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":42924.72,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":5140.64,"maximum":32015.15,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32015.15,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7747.57,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8074.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5140.64,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5825.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7312.62,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5654.68,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8989.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"minimum":4279.76,"maximum":4456.02,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4456.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4279.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"minimum":11339.07,"maximum":11339.07,"setting":"inpatient","payers_information":[{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11339.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":16294.3,"maximum":59576.24,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16294.3,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":59576.24,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16751.6,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":7841.0,"maximum":46758.5,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7841.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":22374.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21513.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13034.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8185.18,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16848.15,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":8297.63,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8492.16,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":46758.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":46758.5,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":5478.94,"maximum":31364.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10995.16,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31364.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":11081.1,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7286.98,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23180.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5478.94,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7737.96,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9003.70,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7360.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":4802.33,"maximum":91486.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12932.28,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5523.66,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":91486.7,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5487.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4802.33,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":6907.0,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7290.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"minimum":1498.14,"maximum":6297.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6297.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4477.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1498.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":5142.42,"maximum":10219.19,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10219.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7408.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5142.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":4386.94,"maximum":28680.32,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28680.32,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12896.43,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6452.02,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8052.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5352.83,"methodology":"other"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":7743.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4386.94,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5888.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":3980.47,"maximum":15008.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15008.57,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8761.9,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3980.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":9812.77,"maximum":9812.77,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9812.77,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":4988.49,"maximum":65540.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18097.70,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":12239.65,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":16177.23,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36373.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6634.69,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15092.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":12283.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7593.84,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":19967.1,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":18370.96,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8774.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10928.24,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":12587.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":65540.62,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4988.49,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12302.21,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":11127.25,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":18073.96,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18073.96,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":2946.74,"maximum":74401.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7917.44,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":7970.17,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7458.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5182.26,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":17891.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7807.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4988.5,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":28453.38,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":74401.65,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7402.04,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7951.86,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4988.49,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4955.40,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2946.74,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7680.66,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36736.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":4247.62,"maximum":19162.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6297.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7786.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5135.76,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":6115.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6113.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4988.5,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":16724.74,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":6239.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4247.62,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":6112.76,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6099.28,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13653.46,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13653.46,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19162.77,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"minimum":3984.93,"maximum":16563.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6466.95,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16563.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3984.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":1159.6,"maximum":83947.1,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4126.0,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9286.17,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":8459.18,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":14916.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7503.95,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7515.62,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6594.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9085.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5212.70,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":11187.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9231.82,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15433.29,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4783.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1159.6,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6130.25,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11353.26,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50873.2,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9086.17,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":25200.51,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":83947.1,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":1584.0,"maximum":20716.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4599.43,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":7398.26,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9284.5,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8091.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7458.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6466.95,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1584.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7576.98,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4501.06,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":20716.98,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7731.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15350.55,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4139.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1622.02,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6910.36,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":6915.48,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7564.62,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":14358.0,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14358.0,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9714.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":7018.96,"maximum":119468.46,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20998.75,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23582.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":21243.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8150.34,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":54005.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":21684.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7018.96,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8965.36,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":21243.28,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":119468.46,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":21559.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":4612.15,"maximum":10158.73,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5581.7,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5691.13,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10158.73,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4612.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"minimum":1011.77,"maximum":22444.64,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1016.8,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5704.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4612.16,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22444.64,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1011.77,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5073.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":1308.19,"maximum":141483.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32838.36,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25888.84,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":94941.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24369.83,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1632.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":53063.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":66886.95,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21436.79,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":7856.0,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":75735.35,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":141483.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28535.13,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":18563.69,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":73855.52,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24637.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1308.19,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":26261.92,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":27964.43,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":48878.49,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28546.41,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":72300.16,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":72300.16,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":12594.0,"maximum":108241.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12594.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":12594.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20673.25,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13563.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17662.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":18069.08,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":20402.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15712.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22872.62,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26184.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18082.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17587.83,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":49041.48,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":39701.5,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18417.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":48787.54,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":18563.69,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":19131.9,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22428.36,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":50583.09,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":18168.65,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18050.81,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18389.16,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":108241.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":108241.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":33650.62,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41985.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":39191.32,"maximum":39191.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":39191.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":1598.84,"maximum":17197.48,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17197.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1598.84,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15763.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"minimum":27992.78,"maximum":28684.33,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28684.33,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27992.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":17353.6,"maximum":42932.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42932.44,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32968.27,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":17353.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":11741.08,"maximum":199374.32,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18597.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11741.08,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":199374.32,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":2297.8,"maximum":348292.92,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39205.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":101291.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44526.44,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348292.92,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37701.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":32267.02,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":70813.93,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":117827.01,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":22616.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2297.8,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":31283.54,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44451.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":72630.4,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21632.38,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21445.59,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16124.51,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":15723.14,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":19370.42,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2738.82,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":17736.95,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23247.68,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":21434.6,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72630.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":11487.34,"maximum":59737.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16546.99,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16536.99,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17546.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11487.34,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":59737.74,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":59737.74,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"minimum":13192.88,"maximum":20136.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20136.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13192.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":13955.56,"maximum":17632.06,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13955.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":17632.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":13788.73,"maximum":67410.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67410.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13788.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":1475.0,"maximum":17269.58,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1475.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13369.16,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11883.69,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":17269.58,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":13768.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":12445.74,"maximum":12445.74,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":12445.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"minimum":7466.80,"maximum":7466.80,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":7466.80,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"minimum":7597.36,"maximum":14178.55,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7597.36,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":14178.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"minimum":23283.13,"maximum":23283.13,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":23283.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"minimum":6768.63,"maximum":12268.92,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6768.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12268.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"minimum":14980.0,"maximum":14980.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"minimum":10021.02,"maximum":23799.36,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10021.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13727.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":22242.1,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":23799.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":30421.17,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12083.88,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":15103.61,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1676.0,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":30421.17,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"minimum":4832.01,"maximum":10484.51,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9474.7,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10484.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4832.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"minimum":22447.06,"maximum":187659.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":187659.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":22447.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":27440.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":2749.91,"maximum":25600.61,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2749.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12083.88,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":25600.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10994.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7694.52,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13292.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":5926.84,"maximum":8894.51,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8894.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5926.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"minimum":19393.56,"maximum":42077.47,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":42077.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":19393.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":19865.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":22223.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"minimum":1845.94,"maximum":22313.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22208.2,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13075.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":17105.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1845.94,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":22313.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":9830.84,"maximum":17533.92,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17533.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13182.31,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12897.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9830.84,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12055.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":5845.26,"maximum":16720.09,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15544.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8924.04,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5845.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":15097.10,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":16720.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":5845.26,"maximum":10405.43,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9590.61,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6042.58,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":5845.26,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5845.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8801.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6429.79,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10405.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"minimum":5122.42,"maximum":5845.27,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5845.27,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5122.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":2509.25,"maximum":17419.75,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17419.75,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8866.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4343.12,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9753.67,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17386.73,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2509.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":2191.06,"maximum":11853.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10858.26,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11853.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6091.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2191.06,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8257.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":5161.68,"maximum":6005.41,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6005.41,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5161.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":9820.83,"maximum":142214.83,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142214.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9820.84,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9820.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":6297.0,"maximum":46719.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":16467.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46719.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13061.7,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8585.23,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6717.61,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9443.74,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":12534.87,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12481.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":8958.06,"maximum":45452.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25188.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18108.38,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45452.4,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39229.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":15813.79,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18097.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9756.23,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":27353.49,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":17478.76,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8958.06,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10014.61,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16166.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18159.31,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18081.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":4941.13,"maximum":70968.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5689.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10181.08,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11918.70,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":11662.97,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10147.25,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70968.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8724.67,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":9562.27,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10197.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6559.91,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10344.13,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4941.13,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6170.50,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":10269.47,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10183.09,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9022.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":5176.17,"maximum":16780.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13814.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6601.4,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15140.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6559.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5176.17,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6521.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":6179.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6179.76,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"minimum":2166.78,"maximum":19063.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19063.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8924.04,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9638.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2166.78,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9816.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":7389.64,"maximum":57493.05,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57493.05,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8724.67,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11122.75,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7990.45,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7389.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":10334.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"minimum":6554.9,"maximum":8258.74,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6700.67,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8083.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8258.74,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":6554.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"minimum":6272.8,"maximum":9106.97,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6272.8,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6559.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7515.08,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9106.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":7443.38,"maximum":7443.38,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7443.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":6196.29,"maximum":59409.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31485.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59409.29,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":47046.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10025.24,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6196.29,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6208.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":4863.37,"maximum":22470.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7362.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4863.39,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4863.37,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6089.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":1616.36,"maximum":14826.51,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14826.51,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1616.36,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":9157.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":14806.34,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6429.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13173.85,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8686.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":5164.81,"maximum":29563.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8391.19,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":6935.56,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8453.36,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5164.82,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":10954.22,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":29563.86,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5164.81,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5793.41,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8456.84,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8398.2,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":17455.40,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":4097.68,"maximum":14842.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4099.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11249.9,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5988.71,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14842.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":5997.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4097.7,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4097.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4507.45,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5964.39,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":14337.07,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14337.07,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":7262.74,"maximum":26724.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7262.74,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26724.86,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15432.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9414.22,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13040.17,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13068.11,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8576.73,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":13242.32,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7955.66,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7786.2,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":13010.99,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9609.32,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":12814.09,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13021.59,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":10107.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.0,"maximum":29960.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8222.29,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8181.5,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23210.63,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19524.55,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":8181.6,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8216.29,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7490.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29960.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6066.94,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7387.8,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23166.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14380.11,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8217.02,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4924.44,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8366.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22185.75,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4523.07,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4336.81,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8249.81,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24515.13,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8187.88,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":18172.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":23146.36,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":6014.42,"maximum":19199.51,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":16511.14,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11397.71,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":16313.88,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6014.42,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7845.05,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8629.56,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":16290.64,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19199.51,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19199.51,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":4119.16,"maximum":89791.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9445.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":6297.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9726.1,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13814.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8101.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5280.45,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":89791.0,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9713.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6630.38,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4119.16,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7641.94,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9975.45,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9715.53,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":9496.58,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":4768.96,"maximum":23073.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11122.59,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23073.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5738.79,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5164.66,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6091.33,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4768.96,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6841.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":1500.0,"maximum":13510.16,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13510.16,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10192.96,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1500.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":72692.69,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":72692.69,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15920.16,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11599.40,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.0,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14760.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9266.35,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14564.84,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11595.43,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2509.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":2424.47,"maximum":30614.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3648.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13257.49,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30023.55,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":30614.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9688.45,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9105.7,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7531.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7284.55,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":24175.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":24175.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":2424.47,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"minimum":15086.57,"maximum":160259.76,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":48072.24,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15086.57,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":21055.53,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":160259.76,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"minimum":19512.56,"maximum":25951.69,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25951.69,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":19512.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"minimum":15480.93,"maximum":15480.93,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15480.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"minimum":16524.76,"maximum":18083.49,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":18083.49,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":16524.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"minimum":6179.86,"maximum":14980.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12570.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6179.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"minimum":15022.52,"maximum":15022.52,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15022.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"minimum":14147.96,"maximum":18271.5,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14147.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":18271.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":11243.1,"maximum":13061.05,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11243.1,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13061.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":11873.69,"maximum":76038.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23369.43,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14477.27,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":16780.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":29227.92,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17885.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11873.69,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":25188.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11931.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":21577.38,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":59811.0,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":76038.89,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":3375.89,"maximum":41700.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":41700.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3375.89,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29748.2,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27114.61,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7490.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12503.93,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31302.87,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16567.48,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11873.69,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11873.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13061.05,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16614.92,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":15651.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":6590.21,"maximum":42729.22,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6590.21,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16780.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12503.93,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":13761.73,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9401.47,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":39021.49,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7531.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":12350.9,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":42729.22,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9401.45,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10341.6,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17047.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"minimum":14736.24,"maximum":14736.24,"setting":"inpatient","payers_information":[{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14736.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"minimum":2051.71,"maximum":25443.88,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12618.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2051.71,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":25443.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"minimum":9746.78,"maximum":127842.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":127842.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9746.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":1000.0,"maximum":75860.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32722.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22398.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19293.8,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27465.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11317.17,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68445.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":17599.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8839.96,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":75860.0,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":51161.11,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":2991.88,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":24687.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":51161.11,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8839.95,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":14559.06,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10532.62,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19530.29,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18462.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":7719.61,"maximum":54377.38,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24249.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7719.61,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54377.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8839.96,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8839.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9297.76,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9723.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"minimum":4301.87,"maximum":7719.61,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7719.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4301.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6492.74,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6384.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":244928.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17775.64,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15582.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28170.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12618.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10636.58,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":244928.19,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10329.4,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12911.31,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":18229.47,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":71115.82,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":6834.76,"maximum":15620.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15620.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6834.76,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":7517.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":6597.86,"maximum":56191.78,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29526.32,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9386.14,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":20721.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":56191.78,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9179.25,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16624.73,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6597.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":1262.4,"maximum":265046.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89000.35,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8954.42,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24249.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7901.98,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47960.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5941.36,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":1262.4,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5941.34,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6535.47,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36748.15,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7450.66,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":265046.7,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":265046.7,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13422.17,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":2557.89,"maximum":16166.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12594.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7789.13,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14581.82,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15432.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3215.10,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6637.59,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7810.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4593.14,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":15938.48,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4593.13,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5052.44,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":2557.89,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":2558.04,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":1934.22,"maximum":38544.19,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11349.78,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38544.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8227.41,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":30098.8,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1934.22,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8456.42,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8839.95,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9050.14,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":18858.28,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18163.26,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":27058.2,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":24898.73,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":24898.73,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":6991.3,"maximum":28510.46,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25170.0,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7719.61,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9949.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9390.63,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6991.3,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":28510.46,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9983.36,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9997.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":16044.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16044.64,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":4301.88,"maximum":51500.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51500.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4301.88,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7535.11,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5379.84,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4732.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":9634.81,"maximum":52734.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16868.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":15221.02,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16814.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10252.23,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":52734.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9634.81,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":11277.44,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16856.17,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16881.5,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11992.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":7115.7,"maximum":52430.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11193.52,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16368.77,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":12978.28,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52430.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7472.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11132.70,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7319.6,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7319.58,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7115.7,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":11132.30,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11295.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":5618.05,"maximum":22148.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5689.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7472.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8376.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5618.07,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5618.05,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6179.86,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":7461.31,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22148.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"minimum":12584.0,"maximum":101557.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86419.13,"methodology":"other"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12584.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":101557.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81714.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":494651.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45274.67,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494651.18,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1632.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":59898.09,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":28675.8,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26787.55,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24235.79,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59867.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"minimum":1957.68,"maximum":104065.14,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7716.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":16786.5,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31204.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32233.6,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":36520.27,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104065.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":24235.81,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":46698.67,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25471.82,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":23861.99,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1957.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":26659.37,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50788.18,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47088.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":59851.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":59851.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":64193.29,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"minimum":47504.0,"maximum":80387.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62170.35,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":47504.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":80387.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"minimum":92701.29,"maximum":92701.29,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":92701.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"minimum":28326.37,"maximum":67335.07,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":29021.11,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":67335.07,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":28326.37,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":31923.21,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":50031.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"minimum":18073.00,"maximum":123896.0,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80924.22,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41535.38,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123896.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":18073.00,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":24235.81,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":55896.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":39875.86,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":23969.66,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40169.5,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26021.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"minimum":11359.0,"maximum":28005.48,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11359.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16540.26,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13191.80,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28005.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":29021.1,"maximum":55492.6,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55492.6,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46512.03,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":47271.51,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":29021.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":8349.18,"maximum":21983.86,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21983.86,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11702.54,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":13817.75,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16392.06,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8349.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":5756.19,"maximum":54484.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25188.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":25188.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5756.19,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":54484.08,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":24687.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8644.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"minimum":2154.46,"maximum":29022.75,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29022.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2154.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":3103.76,"maximum":40415.89,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21821.64,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":40415.89,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3103.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":1245.63,"maximum":31364.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6006.36,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31364.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7541.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14562.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1245.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":1413.21,"maximum":21715.81,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21715.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1413.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":23523.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18890.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12737.47,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":19433.83,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":14536.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1632.0,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18694.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"minimum":2430.61,"maximum":85067.92,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":47177.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":85067.92,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":25275.73,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2430.61,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":44544.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"minimum":18503.65,"maximum":185844.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185844.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18503.65,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":21889.68,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":29326.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"minimum":15432.0,"maximum":317803.22,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15432.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20539.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15442.90,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":15442.89,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":317803.22,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":22957.73,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":16230.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":24090.68,"maximum":1022871.92,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24090.68,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1022871.92,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":32450.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":42364.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":7605.45,"maximum":21493.41,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":21493.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18113.3,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12088.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7605.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"minimum":11730.98,"maximum":29934.36,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11730.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":29934.36,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12625.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"minimum":7453.57,"maximum":39205.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39205.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10428.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7453.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":21476.26,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":23107.91,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"minimum":5186.68,"maximum":37655.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7655.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5186.68,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":37655.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":1319.81,"maximum":259474.31,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":27239.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":29266.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":19718.40,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":24269.84,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":117685.48,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":259474.31,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1319.81,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":14757.85,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26619.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":2542.1,"maximum":55234.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15883.12,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24497.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":19157.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14533.98,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":20964.46,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":55234.19,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":14460.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2542.1,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":15906.0,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20636.9,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":20495.65,"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":4508.0,"maximum":107626.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16140.93,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13608.23,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":15688.35,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":107626.49,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16307.17,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14519.32,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10896.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8506.2,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12261.04,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4508.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":24272.54,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15325.78,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13487.13,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15903.14,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":15698.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"minimum":2951.13,"maximum":28492.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28492.57,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":24806.18,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16303.7,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2951.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":11589.57,"maximum":36377.54,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15089.58,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11589.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":19394.84,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20935.73,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":36377.54,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":36377.54,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":10834.04,"maximum":23710.89,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10834.04,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":23710.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.0,"maximum":185464.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59679.56,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31364.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185464.27,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15564.35,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18245.98,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":36611.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":138957.45,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13396.04,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":16598.53,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97089.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":7134.65,"maximum":38582.98,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7134.65,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17816.74,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":12627.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":12627.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":18268.52,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":38582.98,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":38582.98,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"minimum":20222.44,"maximum":375108.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23705.9,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":375108.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34633.72,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26205.44,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21678.51,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28052.23,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":67030.2,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":20222.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":14263.06,"maximum":400668.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47545.66,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23665.32,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":400668.35,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":31279.72,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47983.6,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24450.76,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23976.45,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21976.9,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":23737.74,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15089.58,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22584.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":14263.06,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15089.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":20443.89,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":22077.06,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":43157.03,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23597.47,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":62896.27,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":62896.27,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":55854.38,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89675.14,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16863.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":7030.9,"maximum":110797.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18336.5,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7030.9,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":83728.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22693.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":18696.95,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76942.73,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15564.35,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18864.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11702.54,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":40952.28,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16325.46,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":12299.35,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19160.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":89661.04,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11702.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9822.46,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12872.77,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":110797.79,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18693.15,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29211.57,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":39263.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"minimum":35389.16,"maximum":39205.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39205.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":35389.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"minimum":9565.62,"maximum":33078.07,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9565.62,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":33078.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"minimum":15682.0,"maximum":25281.64,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":25281.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":24535.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"minimum":10206.89,"maximum":10206.89,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":10206.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"minimum":14864.47,"maximum":216818.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216818.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":23941.54,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":26387.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":85170.77,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":26886.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":14864.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":1536.56,"maximum":17972.49,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17814.66,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1536.56,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17972.49,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15486.92,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":13449.7,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10828.74,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":16853.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":8482.12,"maximum":21118.1,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":16262.97,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11166.08,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":14111.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10828.75,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":21118.1,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":14336.2,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8482.12,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":14864.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"minimum":22489.78,"maximum":24391.93,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24391.93,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":22489.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":13523.16,"maximum":73535.88,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13523.17,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":13523.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":15861.58,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73535.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"minimum":6297.0,"maximum":74686.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":74686.3,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":6641.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13408.68,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":17452.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10246.23,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":24359.33,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10010.40,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"minimum":19489.95,"maximum":51216.07,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":19489.95,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":51216.07,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":29021.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":24473.14,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":33695.28,"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":5454.73,"maximum":20070.06,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19509.25,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17972.49,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":20070.06,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":5454.73,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19810.37,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13513.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7797.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":2480.55,"maximum":52677.55,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":16535.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8568.72,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16385.64,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13513.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2480.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14702.99,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":28785.67,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52677.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":7911.72,"maximum":23549.92,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11997.05,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19516.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":23549.92,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9594.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13511.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7911.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"minimum":8916.72,"maximum":8916.72,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8916.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"minimum":26313.01,"maximum":401233.75,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":401233.75,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":28607.34,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":26616.36,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":46412.47,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":26313.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":9497.5,"maximum":135672.14,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29334.26,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23578.06,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":92922.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21261.87,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":19927.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14388.2,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":135672.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":28917.51,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":81861.13,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9497.5,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":16973.46,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19000.41,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19000.41,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"minimum":6272.8,"maximum":162772.02,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6272.8,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6477.50,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162772.02,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11015.92,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9242.31,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9618.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"minimum":17466.64,"maximum":37331.18,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17466.64,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37331.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"minimum":11484.34,"maximum":109133.06,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11484.34,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":109133.06,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":109133.06,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"minimum":10590.41,"maximum":20623.79,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13081.67,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16970.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12639.38,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13132.81,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10590.41,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20623.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":23969.96,"maximum":31942.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31942.85,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":23969.96,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28532.71,"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":1054.9,"maximum":146650.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":21179.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20931.17,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21715.81,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":20017.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":20938.69,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16327.7,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15569.45,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1054.9,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":16975.06,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":21179.42,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20918.07,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":19488.45,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":146650.91,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"minimum":7323.6,"maximum":9740.37,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9740.37,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7323.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"minimum":2009.95,"maximum":2009.95,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2009.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":13468.44,"maximum":29769.31,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29769.31,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":13468.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":9835.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8536.72,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8096.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9835.35,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7521.27,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2081.78,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7743.26,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8385.67,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":1632.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"minimum":10555.49,"maximum":19996.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19996.26,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14612.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10555.51,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10555.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":10000.08,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10000.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1676.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"minimum":5756.19,"maximum":9070.87,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5756.19,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9070.87,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":11477.33,"maximum":11477.33,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11477.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":7841.06,"maximum":78410.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10855.64,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78410.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10907.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7841.06,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11503.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":7609.25,"maximum":8147.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7609.25,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8147.44,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7981.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"minimum":9918.31,"maximum":28608.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28608.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9918.31,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22027.39,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10920.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":7210.48,"maximum":49451.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49451.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15320.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7614.71,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7210.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8083.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"minimum":14038.8,"maximum":18332.06,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14038.8,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16506.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":18332.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":12314.92,"maximum":12314.92,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":12314.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":6607.26,"maximum":154870.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17079.8,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154870.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14946.45,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18044.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11428.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6607.26,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":45091.75,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":17566.58,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":68653.36,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9018.11,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":16064.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.0,"maximum":138601.70,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8903.27,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":34988.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":11630.31,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9971.89,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31724.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":16503.15,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138601.70,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8622.16,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":12600.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10003.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5186.68,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":14567.46,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19133.34,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10173.36,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4909.65,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":26817.62,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6482.83,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5705.33,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10030.61,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9930.2,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":3670.36,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":52748.61,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":52748.61,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"minimum":13181.89,"maximum":13181.89,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13181.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":2558.04,"maximum":7014.07,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7014.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4215.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4072.13,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5801.11,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2558.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":4215.8,"maximum":14264.82,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14264.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":8378.93,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6310.54,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4215.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":6666.51,"maximum":10843.93,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10843.93,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6666.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8153.35,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8153.33,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8968.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":2041.86,"maximum":23430.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7490.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7014.07,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23430.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5273.76,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4980.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2041.86,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5801.11,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8861.82,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19658.02,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":8359.16,"maximum":12982.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12982.46,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8359.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":8614.17,"maximum":11641.29,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8614.17,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9778.01,"methodology":"percent of total billed charges"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11641.29,"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":6897.7,"maximum":6897.7,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":6897.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":6387.60,"maximum":61448.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":61448.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":14680.11,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7121.42,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":45177.29,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6387.60,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15464.59,"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":4706.5,"maximum":80687.0,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6336.04,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9261.2,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80687.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47639.58,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5918.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8479.69,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7618.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6985.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5718.91,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":6973.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":5875.28,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":17229.28,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5875.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4706.5,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9058.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":8046.76,"maximum":14684.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8046.76,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9319.39,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14270.62,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":14684.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":6156.12,"maximum":163163.42,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":10427.98,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":163163.42,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13814.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8721.40,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6156.12,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10210.39,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8470.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9204.27,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10508.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":5502.95,"maximum":25188.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25188.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8133.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6309.08,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7118.73,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5502.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":11904.78,"maximum":218076.98,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46860.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14210.79,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":218076.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11904.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":1197.32,"maximum":38380.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1197.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38380.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6583.93,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8993.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7352.02,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":15582.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":4215.8,"maximum":4826.74,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4215.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4490.04,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4826.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"minimum":19037.92,"maximum":59609.23,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":59609.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":19037.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"minimum":8253.7,"maximum":8253.7,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8253.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"minimum":20549.44,"maximum":20549.44,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":20549.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"minimum":15908.32,"maximum":54445.97,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54445.97,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15908.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":52343.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"minimum":25413.91,"maximum":117150.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117150.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":25413.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"minimum":16303.46,"maximum":31101.21,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":29485.53,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":31101.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":16303.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":8706.33,"maximum":201888.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201888.44,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16122.90,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11960.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":17657.45,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8993.1,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":84954.48,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8706.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":7011.00,"maximum":60958.52,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7489.74,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":60958.52,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7011.00,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":14546.48,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":52128.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"minimum":4974.49,"maximum":22711.55,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22711.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4974.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"minimum":3764.4,"maximum":3764.4,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3764.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":8678.8,"maximum":10927.73,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8678.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":10927.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":8163.84,"maximum":9861.24,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":9861.24,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8163.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"minimum":4609.16,"maximum":4609.16,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4609.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"minimum":5264.75,"maximum":9453.36,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5264.75,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9453.36,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7885.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"minimum":17575.80,"maximum":17575.80,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":17575.80,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"minimum":4790.32,"maximum":4790.32,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4790.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"minimum":3764.4,"maximum":3764.4,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3764.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":5078.87,"maximum":23162.41,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23023.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6887.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7801.03,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7801.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5078.87,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14748.58,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":23162.41,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23162.41,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":2057.28,"maximum":41950.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17067.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9162.02,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6906.92,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":30864.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41950.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10943.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6887.62,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15878.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9154.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4886.36,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":13519.19,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":5738.2,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13611.91,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5178.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2057.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5662.67,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":19803.7,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9157.12,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":9142.53,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"minimum":11875.86,"maximum":31625.49,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11875.86,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15262.57,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":31625.49,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13288.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":4880.4,"maximum":33453.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33453.44,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":6907.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8083.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7601.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4880.4,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9764.96,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":25343.71,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6084.48,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6675.31,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9551.62,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16764.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"minimum":14513.02,"maximum":14513.02,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":14513.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"minimum":3764.4,"maximum":12594.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12594.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9051.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3764.4,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4974.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"minimum":11245.82,"maximum":34285.88,"setting":"inpatient","payers_information":[{"payer_name":"Covered Ca Molina","plan_name":"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":34285.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11245.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"minimum":21540.17,"maximum":21540.17,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21540.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"minimum":19924.62,"maximum":19924.62,"setting":"inpatient","payers_information":[{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":19924.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":10246.21,"maximum":42043.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19526.54,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15806.63,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10465.53,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13523.17,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":29132.44,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10246.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":11270.83,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":30560.57,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19947.63,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":19132.63,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":42043.84,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"minimum":83467.67,"maximum":83467.67,"setting":"inpatient","payers_information":[{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":83467.67,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":83467.67,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"minimum":33972.0,"maximum":37739.22,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":33972.0,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":37739.22,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":37739.22,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"minimum":14210.79,"maximum":18285.09,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14210.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":18285.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":6486.22,"maximum":71261.85,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9701.76,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6486.22,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8993.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":17413.51,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":19072.34,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":71261.85,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":71261.85,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"minimum":14210.79,"maximum":14210.79,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14210.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":44114.64,"maximum":44114.64,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":44114.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"minimum":28672.62,"maximum":28672.62,"setting":"inpatient","payers_information":[{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28672.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":19118.2,"maximum":36858.8,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":19118.2,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":36858.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":11076.28,"maximum":59920.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59920.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25618.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11076.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":5576.43,"maximum":80692.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":25188.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":12814.90,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14676.36,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7490.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33444.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9636.54,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":14628.37,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8512.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7245.53,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":21917.96,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7757.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":80692.08,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7028.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11170.39,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7970.07,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":5576.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":1635.21,"maximum":54821.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22523.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54821.5,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9468.75,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16609.34,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9558.07,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":12483.73,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35297.9,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6481.6,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1635.21,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5758.52,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12496.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21226.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9558.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5574.46,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":5043.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":13830.85,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10472.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9506.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9718.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":21204.74,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4873.38,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5360.72,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9539.68,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6203.64,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9547.05,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":20697.65,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":4873.38,"maximum":35549.57,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17107.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16530.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6481.6,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35549.57,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4873.4,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":11784.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":9512.49,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4873.38,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5360.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":18656.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18656.66,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":2509.37,"maximum":22229.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13481.6,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13464.70,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4057.36,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3492.01,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13391.26,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3924.34,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13028.1,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13428.63,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6507.87,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11519.55,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7886.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9766.66,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7158.64,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":13450.29,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":12881.66,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22229.0,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2509.37,"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":1500.0,"maximum":88710.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22756.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8237.21,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15392.58,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1500.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8228.82,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5857.27,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":3112.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8291.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4674.22,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":22848.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":4688.43,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8192.06,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4848.32,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5328.79,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6150.13,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":22009.83,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8192.07,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":88710.15,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":51283.8,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":51283.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":1400.0,"maximum":30295.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30295.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":5397.85,"maximum":23345.2,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23345.2,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13446.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9823.85,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5397.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":5397.87,"maximum":80146.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9816.46,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11032.3,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":80146.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9358.31,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26182.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10635.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5397.87,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10856.63,"methodology":"percent of total billed charges"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10621.7,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10592.44,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":25267.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":4048.65,"maximum":4138.39,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4048.65,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4138.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"minimum":54057.98,"maximum":54057.98,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":54057.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"minimum":26239.0,"maximum":26239.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":26239.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"minimum":58987.44,"maximum":58987.44,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":58987.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"minimum":10992.56,"maximum":18148.14,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10992.56,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13980.57,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18148.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":52097.34,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7056.9,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13422.85,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":15096.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12137.93,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":52097.34,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":1207.98,"maximum":26472.91,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26472.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1207.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25341.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":7007.37,"maximum":22713.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15542.33,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7007.37,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22713.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13538.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7698.94,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":20253.54,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11759.57,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":15268.53,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":13381.87,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13505.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":6843.14,"maximum":15682.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14274.56,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":9961.65,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15682.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9641.86,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15457.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7249.53,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6843.14,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9682.1,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10901.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"minimum":14478.72,"maximum":34210.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":34210.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14478.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"minimum":6851.3,"maximum":6851.3,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":6851.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"minimum":17208.49,"maximum":17208.49,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17208.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":26412.47,"maximum":28008.94,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":28008.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":26412.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"minimum":6947.06,"maximum":13880.5,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13880.5,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6947.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"minimum":8211.93,"maximum":8211.93,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":8211.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":8483.64,"maximum":60663.07,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60663.07,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":53616.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15523.08,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":40703.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8483.64,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":14758.86,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":15789.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":5244.72,"maximum":48221.77,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"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":21834.67,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22716.67,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48221.77,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11298.68,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5244.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":21136.20,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":12428.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":1213.78,"maximum":94170.77,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30922.71,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":7585.07,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25170.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94170.77,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11111.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13456.05,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":15114.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8354.53,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":15045.37,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10713.88,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11083.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1213.78,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8267.34,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":15191.92,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14938.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.0,"maximum":78682.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8727.71,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13013.12,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9479.66,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":9107.12,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9204.23,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14916.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6975.48,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":8697.46,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9381.06,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5354.25,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":5892.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16458.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5244.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2084.47,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5769.19,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8843.09,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":6422.86,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8355.87,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9256.13,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8599.29,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":78682.16,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":37261.20,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":4635.18,"maximum":6597.52,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6164.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6597.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4635.18,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5418.17,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":6445.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"minimum":23523.0,"maximum":23523.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":6427.78,"maximum":31485.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":31485.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7707.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9547.6,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6427.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":5686.62,"maximum":44536.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":25188.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8893.42,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44536.55,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6875.63,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7834.94,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10782.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6975.29,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":17241.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":17688.58,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9742.85,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6975.27,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5686.62,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":12133.9,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11943.26,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":6397.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":1351.06,"maximum":29194.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7056.91,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1351.06,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15682.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7650.36,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6875.63,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7629.10,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29194.02,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24866.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8446.06,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5169.66,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":12136.47,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5025.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5686.62,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8531.81,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":6972.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8435.4,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":3988.25,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":27272.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27272.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":8683.37,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"minimum":7104.59,"maximum":7104.59,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7104.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":2557.96,"maximum":7897.00,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7897.00,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7104.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6295.68,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5026.13,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":2557.96,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":4428.18,"maximum":32029.98,"setting":"inpatient","payers_information":[{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4428.18,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":32029.98,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":32029.98,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":8216.69,"maximum":48773.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16735.6,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":16822.71,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9934.73,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":48773.99,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16781.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12300.07,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9296.38,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9884.89,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14005.26,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8216.69,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10667.37,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":12099.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16750.62,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":10242.71,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":27343.63,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27343.63,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":2186.37,"maximum":21959.48,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":10472.64,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7134.55,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":10284.73,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10547.68,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5775.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2186.37,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5825.34,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":10851.77,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10522.83,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":21959.48,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"minimum":5295.78,"maximum":35266.16,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7328.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5354.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5295.78,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":35266.16,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":10701.62,"maximum":22024.97,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10701.62,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22024.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"minimum":2352.3,"maximum":10701.64,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2352.3,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10701.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":6237.62,"maximum":6237.62,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6237.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"minimum":5305.78,"maximum":9156.26,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5305.78,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9156.26,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8611.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"minimum":8649.12,"maximum":8649.12,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":8649.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"minimum":5889.3,"maximum":16128.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16128.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8412.82,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5889.3,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11478.22,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9846.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"minimum":1185.46,"maximum":13788.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":7885.46,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13788.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1185.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":6942.44,"maximum":14801.57,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":6942.44,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14801.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":2051.48,"maximum":7056.67,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7056.67,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5305.78,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3980.58,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2051.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"minimum":11294.05,"maximum":11294.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11294.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"minimum":3980.59,"maximum":3980.59,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3980.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"minimum":14652.49,"maximum":14652.49,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14652.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":10174.16,"maximum":22360.12,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10174.16,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":22360.12,"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":6248.01,"maximum":24737.06,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10260.22,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9778.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10941.10,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6248.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8000.21,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":18126.07,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8800.21,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12219.86,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":24737.06,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"minimum":7563.82,"maximum":41940.55,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41940.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7563.82,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13417.77,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":18991.83,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18985.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"minimum":8137.61,"maximum":14980.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8137.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"minimum":8768.4,"maximum":8768.4,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8768.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"minimum":1068.59,"maximum":46068.1,"setting":"inpatient","payers_information":[{"payer_name":"Covered Ca Molina","plan_name":"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":1068.59,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10327.29,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":46068.1,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":46068.1,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"minimum":7209.48,"maximum":7209.48,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7209.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":12416.07,"maximum":16378.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12416.07,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16378.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"minimum":6303.22,"maximum":9681.26,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6303.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9681.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"minimum":5381.85,"maximum":21816.41,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5381.85,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":21816.41,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"minimum":1261.84,"maximum":25188.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25188.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4271.86,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1261.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"minimum":4155.83,"maximum":10195.9,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10195.9,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4155.83,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4467.02,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5501.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":3541.2,"maximum":31586.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6907.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4709.77,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3541.2,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":31586.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":4245.82,"maximum":18405.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11014.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8078.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16356.63,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7360.63,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7926.8,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":18405.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5646.94,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7099.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4245.95,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4245.82,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4670.4,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":16691.49,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":3746.37,"maximum":14980.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11761.5,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10271.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7723.76,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3746.37,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8495.23,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":7161.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"minimum":4885.09,"maximum":22504.85,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5814.04,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":22504.85,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5813.23,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4885.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":2442.0,"maximum":23523.0,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4992.7,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6297.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23523.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12320.34,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4290.76,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3354.02,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2811.84,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2442.0,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4416.47,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":14744.11,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14744.11,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"minimum":3020.02,"maximum":7841.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3671.98,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4598.12,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3020.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":4711.68,"maximum":14493.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4711.68,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6436.82,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14493.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":6436.82,"maximum":31501.22,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":31501.22,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8560.93,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6436.82,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7080.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":5563.66,"maximum":14493.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8078.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":8078.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8078.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11516.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11324.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":12270.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7398.79,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5563.66,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":13141.16,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14493.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6436.79,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6119.3,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9100.75,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":6672.02,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6672.02,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":7321.59,"maximum":65870.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10833.5,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16370.50,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20158.2,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65870.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11248.62,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18862.42,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8457.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8457.61,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7321.59,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":23791.8,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24814.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":2760.65,"maximum":80338.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8078.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15053.0,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16240.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10281.13,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11199.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7221.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8179.02,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12780.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6656.22,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":9059.2,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":12270.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":2760.65,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14493.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":80338.8,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14493.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6655.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6588.57,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10960.13,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45118.62,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":13263.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13263.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":20094.01,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8692.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":4219.21,"maximum":24540.0,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8598.29,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8078.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":8078.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7987.07,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":11955.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11737.32,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9059.2,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":6826.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11366.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":24540.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16467.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7221.74,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15951.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11760.0,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":4219.21,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5429.98,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":12270.0,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":14600.01,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":13615.25,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9420.45,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5429.88,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5972.87,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11792.94,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":14605.34,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8594.63,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8598.29,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":9582.44,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":16012.92,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16012.92,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":20400.94,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16484.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":1707.54,"maximum":10966.82,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1995.86,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10966.82,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1707.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":48810.89,"maximum":48810.89,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":48810.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":48810.89,"maximum":373915.45,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":373915.45,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":48810.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":1232.11,"maximum":4972.88,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1238.02,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1511.37,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":4972.88,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1232.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":2147.8,"maximum":4951.16,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2147.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2215.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4951.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1023.92,"maximum":40238.95,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2086.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1238.01,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3707.21,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":1853.6,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1288.70,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":40238.95,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":40238.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1023.92,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":4350.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4350.59,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1006.00,"maximum":3961.48,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1238.02,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3531.5,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3961.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1006.00,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":1634.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"minimum":6533.27,"maximum":7899.32,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7899.32,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6533.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"minimum":5940.3,"maximum":16311.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":7314.72,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5940.3,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":16311.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6533.27,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":16199.72,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":5521.87,"maximum":10624.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10624.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7537.24,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5667.63,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5521.87,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6233.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"minimum":7789.85,"maximum":332045.45,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":332045.45,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7789.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"minimum":55149.24,"maximum":144740.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":144740.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":74910.29,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":55149.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"minimum":33634.0,"maximum":33634.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":33634.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"minimum":16921.06,"maximum":16921.06,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":16921.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":3690.32,"maximum":21811.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11014.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11014.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":21811.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10644.8,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11324.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16467.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4908.13,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9918.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3691.07,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14493.0,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3690.32,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4059.35,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6382.04,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":12888.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12888.64,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":3690.32,"maximum":14493.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8078.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13924.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12863.2,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4908.13,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9570.6,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10598.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3691.07,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":12118.9,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":10936.91,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14330.5,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14493.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3690.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7679.15,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4059.35,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7437.97,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13367.48,"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":3229.9,"maximum":39297.5,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4798.31,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8078.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":8078.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8078.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":4039.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10226.29,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16986.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3713.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10324.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8493.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":6587.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13174.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4295.77,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5869.98,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13691.7,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8696.6,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":11515.94,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3230.62,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":10874.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":12270.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":10122.2,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":13427.47,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":9632.51,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14493.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":39081.6,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":11255.25,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18103.12,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3229.9,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5339.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3552.89,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5609.27,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":9766.76,"methodology":"other"},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"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":8004.7,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4796.27,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39297.5,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":10294.81,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":11098.94,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11098.94,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":10156.48,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11777.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":9918.31,"maximum":22646.33,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":22545.28,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9918.31,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22646.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":6390.29,"maximum":77457.65,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":12539.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6390.29,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77457.65,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"minimum":5335.81,"maximum":9855.21,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5335.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9849.95,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9855.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":5866.59,"maximum":77323.57,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55940.42,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14238.46,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7928.61,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":14253.74,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5961.37,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11342.19,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5866.59,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6347.03,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":77323.57,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":77323.57,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":4156.74,"maximum":19494.96,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":9585.04,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7928.61,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9575.23,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5866.6,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4156.74,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4572.41,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9579.04,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8359.45,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":19494.96,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":19494.96,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":6163.54,"maximum":42035.81,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":15853.27,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8197.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10145.39,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10531.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":42035.81,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6163.54,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8927.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":18860.45,"maximum":31597.04,"setting":"inpatient","payers_information":[{"payer_name":"Covered Ca Molina","plan_name":"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":31597.04,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":18860.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":8310.47,"maximum":36402.92,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8310.47,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":36402.92,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"minimum":4156.74,"maximum":4190.05,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4190.05,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4156.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"minimum":9360.39,"maximum":9921.00,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9360.39,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9921.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"minimum":5460.0,"maximum":11392.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5460.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11392.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7828.79,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7828.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"minimum":4359.13,"maximum":6055.45,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4359.13,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5504.95,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":6055.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"minimum":1086.02,"maximum":45478.32,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":1086.02,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45478.32,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":45270.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"minimum":10197.53,"maximum":13090.77,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13090.77,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10197.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"minimum":20356.44,"maximum":20356.44,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20356.44,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"minimum":83900.0,"maximum":83900.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83900.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":2899.96,"maximum":8090.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4320.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4379.63,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":2899.96,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8090.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3219.29,"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":2926.63,"maximum":18891.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7840.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4719.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3892.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2927.19,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2926.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3219.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":2174.96,"maximum":16378.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4181.98,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6251.27,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":8120.44,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14980.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2892.7,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":16378.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5748.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2174.97,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15167.57,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2174.96,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2494.31,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":4382.83,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4382.83,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":6516.72,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"minimum":54882.91,"maximum":54882.91,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":54882.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"minimum":4005.0,"maximum":59587.23,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4005.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":59587.23,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":20241.68,"maximum":29382.4,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":29382.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":20241.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":24171.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":9791.8,"maximum":23699.67,"setting":"inpatient","payers_information":[{"payer_name":"Covered Ca Molina","plan_name":"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":23699.67,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9791.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":28493.14,"maximum":28493.14,"setting":"inpatient","payers_information":[{"payer_name":"Covered Ca Molina","plan_name":"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":28493.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":1654.0,"maximum":895324.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":17066.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48553.52,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":48563.52,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54887.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":353080.04,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49437.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16862.27,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1654.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80341.85,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8074.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":48467.58,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":28697.49,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":165230.29,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":26587.64,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":48419.41,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":46283.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":89145.71,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":37354.59,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":22902.79,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":48587.04,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":895324.67,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":49073.44,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":47814.73,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":53877.62,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82879.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":12678.4,"maximum":136634.80,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19881.97,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":19786.13,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29960.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16862.27,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13112.63,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":19798.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12678.41,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":41605.72,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12678.4,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":13946.24,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":45681.92,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":136634.80,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":136634.80,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":5214.55,"maximum":42252.21,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31364.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32885.24,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":34063.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":42252.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":38936.68,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":21439.09,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":5214.55,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":6137.78,"maximum":16071.83,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6137.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11801.63,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16071.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"minimum":10046.53,"maximum":13111.35,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":13111.35,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10046.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":7046.34,"maximum":49264.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16939.62,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":34814.93,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47046.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23656.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13403.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18568.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10078.08,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":49264.23,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13871.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7046.34,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18330.71,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":23945.7,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":4747.77,"maximum":6464.29,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6464.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6376.75,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6405.76,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4747.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":4654.73,"maximum":6444.33,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6444.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4845.37,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4654.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"minimum":2310.22,"maximum":15467.0,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4468.03,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":15467.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2310.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":4914.82,"maximum":15558.04,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9088.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15558.04,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":5892.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9252.55,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4914.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"minimum":9755.79,"maximum":77892.92,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77892.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9755.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":2450.0,"maximum":150258.0,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":66961.29,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17452.71,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":68294.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":32344.69,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":57436.00,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3481.06,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":19197.96,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2450.0,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":66970.05,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":150258.0,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":150258.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":7084.81,"maximum":91174.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":91174.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7692.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19453.87,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8359.34,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23166.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":35030.46,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19969.24,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":19533.47,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19475.04,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":38234.53,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33859.75,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12670.34,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":11976.77,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11895.05,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12778.50,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31805.73,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23180.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":19509.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9526.58,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":37287.98,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":23632.06,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":29518.36,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":69026.5,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":16458.0,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":18342.78,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18922.83,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":19819.1,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":17452.69,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":24957.20,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11338.10,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7084.81,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":18604.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":10479.23,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":19483.1,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":19031.6,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":61310.08,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19425.94,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":17922.84,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":56453.45,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22736.44,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22736.44,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":24275.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28944.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":184307.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18891.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6297.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10677.62,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16580.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15682.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":15682.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14807.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24386.04,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8481.05,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":5865.89,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5994.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":21026.98,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10645.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6376.75,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":27628.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":15738.03,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":21741.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10781.86,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":6078.13,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":39416.88,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6376.73,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":7014.4,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":10755.31,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45534.99,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":22761.24,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":184307.35,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5454.78,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":8831.52,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":20328.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20328.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":3132.28,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16673.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"minimum":3757.39,"maximum":143082.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9881.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9913.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3757.39,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":143082.75,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":16808.96,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"minimum":3692.33,"maximum":5358.7,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3692.33,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5358.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"minimum":13218.79,"maximum":74900.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16720.47,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74900.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13218.79,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14350.45,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":14862.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":3186.87,"maximum":218384.12,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":14245.21,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3186.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12574.58,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":218384.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":218384.12,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"minimum":15012.71,"maximum":15012.71,"setting":"inpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":15012.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":3114.0,"maximum":22019.56,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4483.47,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7810.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3371.05,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":17764.55,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3378.54,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3708.13,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":6759.85,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3114.0,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22019.56,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":4501.05,"maximum":95345.44,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95345.44,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10295.48,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7740.97,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4501.05,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":75582.82,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7740.96,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11400.84,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":8515.06,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13557.84,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":28824.3,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":28824.3,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":90706.28,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":1676.0,"maximum":167162.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90515.65,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18857.8,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9152.65,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16780.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":14006.98,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16166.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5986.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4501.06,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5625.8,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7593.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":167162.6,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18458.48,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4501.05,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1676.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4951.16,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":9127.76,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9202.50,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":92302.55,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":11942.09,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11942.09,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18785.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"minimum":16943.25,"maximum":244467.13,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":16943.25,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":244467.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"minimum":5466.93,"maximum":58420.0,"setting":"inpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58420.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5466.93,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":20721.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11724.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8613.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"minimum":11492.35,"maximum":198553.68,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11492.35,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":198553.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":37589.46,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":81572.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"minimum":10072.06,"maximum":11492.35,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11492.35,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10072.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"minimum":15908.32,"maximum":22057.33,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15908.32,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":22057.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":17352.62,"maximum":66042.23,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38829.02,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28878.98,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":38651.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17352.62,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":66042.23,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24631.83,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":37070.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":58373.94,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":54539.27,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":54539.27,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":11969.78,"maximum":16340.70,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14949.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11969.78,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16340.70,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"minimum":9943.96,"maximum":114620.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51891.52,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114620.67,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15696.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9943.96,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10773.19,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12879.77,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":15659.35,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"minimum":16263.49,"maximum":16263.49,"setting":"inpatient","payers_information":[{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16263.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"minimum":2138.26,"maximum":51172.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":51172.7,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9558.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9567.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":6592.19,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7648.67,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2138.26,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":41362.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":41362.24,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"minimum":12509.76,"maximum":17323.68,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":17323.68,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":12509.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"minimum":2784.52,"maximum":18779.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7139.23,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3703.39,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2784.52,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7250.86,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":18779.67,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":2790.0,"maximum":82240.49,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14035.14,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16332.26,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51120.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8783.24,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16389.12,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7149.44,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":19536.64,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":16727.08,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":16963.11,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":66490.14,"methodology":"percent of total billed charges"},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82240.49,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6603.94,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":4787.1,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16469.64,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16191.13,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":16101.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":4006.74,"maximum":24115.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5689.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11761.5,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5899.20,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":4658.08,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9272.0,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":4006.74,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":24115.94,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4519.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7494.54,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5085.47,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22745.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":2356.72,"maximum":104893.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12594.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83900.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104893.01,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11316.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":18286.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7469.73,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":14916.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2356.72,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18186.39,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":2424.47,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2424.47,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":5851.28,"maximum":14731.0,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14731.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11316.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":10760.34,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5851.28,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":9320.1,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10479.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":2838.57,"maximum":10467.77,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4739.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10467.77,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2838.57,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5851.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"minimum":8123.32,"maximum":25170.0,"setting":"inpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25170.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8123.32,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":14201.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":15269.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"minimum":4413.8,"maximum":92801.73,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":10539.5,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":92801.73,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4413.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"minimum":9090.17,"maximum":9090.17,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9090.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"minimum":31725.77,"maximum":31725.77,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":31725.77,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":9609.96,"maximum":32051.23,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32051.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9609.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":4546.82,"maximum":7974.67,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7771.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":7974.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4546.82,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7148.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":3272.96,"maximum":28352.53,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8361.99,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":9795.1,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7111.26,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4957.16,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8350.17,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3272.96,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":8486.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3932.13,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8579.75,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7624.0,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":28352.53,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"minimum":3393.20,"maximum":28354.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3393.20,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28354.17,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24567.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5212.70,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":6306.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":5339.8,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5212.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4538.07,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5594.13,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6153.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"minimum":54428.3,"maximum":116009.08,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":116009.08,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":54428.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":1400.0,"maximum":406945.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":406945.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1400.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38598.06,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":215912.41,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":393777.67,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30082.32,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":27765.22,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":14444.83,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":29274.24,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":41710.94,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":38274.46,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37679.72,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":35353.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"minimum":10928.65,"maximum":661808.97,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147276.66,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10928.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25922.93,"methodology":"other"},{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24801.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":31030.42,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":661808.97,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":187438.11,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":108452.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":290371.38,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":51481.29,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":24393.44,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":86665.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"minimum":27696.89,"maximum":543230.25,"setting":"inpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65313.82,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117099.99,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":198852.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112993.46,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27696.89,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":543230.25,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":29021.11,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":105508.5,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":71050.08,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":38237.00,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":39149.42,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":31923.21,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":183013.67,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":52651.47,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":252864.53,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41485.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"minimum":11427.28,"maximum":516549.25,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":278766.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":516549.25,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11427.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12203.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":24903.39,"maximum":143773.16,"setting":"inpatient","payers_information":[{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":27744.8,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":43580.19,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":143773.16,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":24903.39,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":26978.20,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"minimum":2250.0,"maximum":117511.0,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2250.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":80268.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15118.93,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117511.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":15094.93,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13666.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":14555.08,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15402.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":40523.52,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8357.83,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9195.47,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":96213.72,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15634.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"minimum":7801.76,"maximum":94156.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9440.02,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":94156.74,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":87457.93,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7801.76,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":8999.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":13796.06,"maximum":29129.25,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29129.25,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":28564.62,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":21901.71,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":21901.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13796.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"minimum":9011.12,"maximum":24929.13,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9011.12,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":24929.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"minimum":5898.4,"maximum":14545.43,"setting":"inpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5898.4,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14545.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":7841.0,"maximum":246322.33,"setting":"inpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7841.0,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":31946.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":15444.61,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":40900.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9302.68,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":246322.33,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48085.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":2901.13,"maximum":24823.56,"setting":"inpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24823.56,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8931.09,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":11780.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":24823.56,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10945.36,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8488.22,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2901.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"minimum":11530.38,"maximum":22864.59,"setting":"inpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11530.38,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12920.62,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":16039.87,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":36.50,"estimated_amount":22864.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":22864.59,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":11083.35,"maximum":41015.51,"setting":"inpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22470.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41015.51,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11083.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":32209.59,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":27534.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":8584.48,"maximum":107157.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19653.27,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23273.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8584.48,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":10685.61,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":107157.12,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10685.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":9029.15,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":9173.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"minimum":10685.61,"maximum":171284.88,"setting":"inpatient","payers_information":[{"payer_name":"California Children Service","plan_name":"Medi-Cal","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13357.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":13357.02,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":171284.88,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":10685.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"minimum":2074.9,"maximum":39999.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37782.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39999.33,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11994.09,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":31234.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11559.72,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5186.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2074.9,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":31543.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, human-lans, per i.u","code_information":[{"code":"0702","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":7902.23,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7902.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj secukinumab intrav 1mg","code_information":[{"code":"0725","type":"APC"}],"standard_charges":[{"minimum":2479.47,"maximum":2479.47,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2479.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, cyclophosphamide, nos","code_information":[{"code":"0743","type":"APC"}],"standard_charges":[{"minimum":7675.08,"maximum":7675.08,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":7675.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"minimum":38.46,"maximum":1487.59,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1144.18,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":1487.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":38.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, donanemab-azbt, 2 mg","code_information":[{"code":"0765","type":"APC"}],"standard_charges":[{"minimum":9194.09,"maximum":9194.09,"setting":"outpatient","payers_information":[{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":9194.09,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9194.09,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Indium in-111 auto wbc","code_information":[{"code":"0777","type":"APC"}],"standard_charges":[{"minimum":308.39,"maximum":1030.64,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":308.39,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1030.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate","code_information":[{"code":"0800","type":"APC"}],"standard_charges":[{"minimum":108.53,"maximum":108.53,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":108.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alpha 1 proteinase inhibitor","code_information":[{"code":"0901","type":"APC"}],"standard_charges":[{"minimum":2271.00,"maximum":2271.00,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2271.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gammagard liquid injection","code_information":[{"code":"0944","type":"APC"}],"standard_charges":[{"minimum":3744.71,"maximum":8141.16,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":8141.16,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3744.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gamunex-C/Gammaked","code_information":[{"code":"0948","type":"APC"}],"standard_charges":[{"minimum":4352.16,"maximum":4352.16,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":4352.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Albumin (human), 25%, 50ml","code_information":[{"code":"0965","type":"APC"}],"standard_charges":[{"minimum":242.31,"maximum":242.31,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":242.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Octreotide injection, depot","code_information":[{"code":"1207","type":"APC"}],"standard_charges":[{"minimum":7486.18,"maximum":7486.18,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":7486.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj IVIG privigen 500 mg","code_information":[{"code":"1214","type":"APC"}],"standard_charges":[{"minimum":2528.12,"maximum":5815.11,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3197.00,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5493.08,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5815.11,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2528.12,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3311.52,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":4313.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ferumoxytol, non-esrd","code_information":[{"code":"1297","type":"APC"}],"standard_charges":[{"minimum":223.94,"maximum":923.81,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":792.44,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":223.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":923.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Belimumab injection","code_information":[{"code":"1353","type":"APC"}],"standard_charges":[{"minimum":932.07,"maximum":17280.84,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":17280.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3037.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":932.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Eribulin mesylate injection","code_information":[{"code":"1426","type":"APC"}],"standard_charges":[{"minimum":12555.99,"maximum":12555.99,"setting":"outpatient","payers_information":[{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":12555.99,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12555.99,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Injection, Pertuzumab, 1 mg","code_information":[{"code":"1471","type":"APC"}],"standard_charges":[{"minimum":6390.36,"maximum":77847.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12972.00,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6390.36,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13605.71,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":77847.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11989.49,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":67692.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":67692.64,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Golimumab for iv use 1mg","code_information":[{"code":"1475","type":"APC"}],"standard_charges":[{"minimum":20.0,"maximum":5795.15,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"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":20.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3215.02,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.05,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5795.15,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":4791.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":546.03,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1998.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Obinutuzumab inj","code_information":[{"code":"1476","type":"APC"}],"standard_charges":[{"minimum":7944.03,"maximum":16159.88,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":16159.88,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":7944.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ferumoxytol, esrd use","code_information":[{"code":"1485","type":"APC"}],"standard_charges":[{"minimum":827.11,"maximum":827.11,"setting":"outpatient","payers_information":[{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":827.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj vedolizumab iv 1 mg","code_information":[{"code":"1489","type":"APC"}],"standard_charges":[{"minimum":358.69,"maximum":18841.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6709.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6558.66,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":358.69,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1491.86,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":5219.17,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18841.2,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":6500.7,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":7018.62,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7018.62,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj pembrolizumab","code_information":[{"code":"1490","type":"APC"}],"standard_charges":[{"minimum":102.36,"maximum":57861.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11894.75,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57861.56,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":15028.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":11854.88,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9623.47,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":25255.75,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":11924.7,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1271.3,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":102.36,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12627.6,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":11543.85,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":16972.45,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":34176.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":34176.43,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Trastuzumab injection","code_information":[{"code":"1613","type":"APC"}],"standard_charges":[{"minimum":805.07,"maximum":11196.53,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":805.07,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":3198.26,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":11196.53,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Hep b ig, im","code_information":[{"code":"1630","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tetanus immune globulin inj","code_information":[{"code":"1670","type":"APC"}],"standard_charges":[{"minimum":11192.5,"maximum":11192.5,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11192.5,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Paclitaxel protein bound","code_information":[{"code":"1712","type":"APC"}],"standard_charges":[{"minimum":58388.28,"maximum":58388.28,"setting":"outpatient","payers_information":[{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":58388.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, dalbavancin","code_information":[{"code":"1823","type":"APC"}],"standard_charges":[{"minimum":34.1,"maximum":25799.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17691.46,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25799.04,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":9849.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":7222.12,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":34.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4870.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"minimum":616.66,"maximum":4806.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4806.7,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":616.66,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":2871.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1110.08,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inflectra","code_information":[{"code":"1847","type":"APC"}],"standard_charges":[{"minimum":6.94,"maximum":18304.33,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1549.34,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":18304.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":846.36,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":741.62,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":716.9,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11333.39,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":16917.46,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":813.51,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1318.79,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":13652.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13652.18,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Immune globulin, powder","code_information":[{"code":"2731","type":"APC"}],"standard_charges":[{"minimum":5203.74,"maximum":5203.74,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":5203.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":24.20,"maximum":2223.28,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.16,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":323.82,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1254.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.12,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.20,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":698.50,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":161.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":161.86,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":2223.28,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":236.93,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":320.34,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":87.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":65.01,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":161.12,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":491.22,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.16,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":599.18,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":226.68,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":445.92,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":149.48,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":300.23,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":300.23,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":240.70,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":714.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":21.77,"maximum":1419.90,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.93,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":117.6,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1030.05,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":527.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.88,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":357.2,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1419.90,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":697.64,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":110.51,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":1350.55,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":668.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.45,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.93,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":110.51,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1331.22,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":124.25,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":111.88,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":823.99,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":252.22,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117.6,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":110.09,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":99.2,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":947.25,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":62.21,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":117.6,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":173.41,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":968.36,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":503.44,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":76.09,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.64,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":110.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":21.77,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":288.42,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":30.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":109.16,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":110.09,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":111.44,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110.93,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.4,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.72,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":111.04,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":41.03,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":243.99,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":243.99,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":200.34,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":379.16,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":117.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":34.97,"maximum":2618.12,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.35,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2070.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":1987.05,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2157.65,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2618.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.53,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2243.58,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1977.15,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1728.29,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1977.15,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":1977.15,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1907.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":868.54,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.99,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":202.06,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.62,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1148.72,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2058.75,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1045.91,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1153.05,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":787.06,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.08,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":201.08,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.08,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1977.15,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1211.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2054.55,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":2054.55,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":201.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":201.08,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"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":1997.7,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":1977.15,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1995.12,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1627.93,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":531.31,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":316.74,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":702.38,"methodology":"other"},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.97,"methodology":"other"},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2143.88,"methodology":"other"},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – 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":200.26,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2378.35,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":1547.89,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.26,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":204.35,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":34.97,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":531.31,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":34.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":201.08,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":47.16,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":256.48,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":201.08,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.18,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":720.77,"methodology":"other"},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1528.16,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.35,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576.43,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":201.27,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":202.67,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1977.15,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":730.42,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":730.42,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":745.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":872.48,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":63.97,"maximum":5181.95,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.49,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":2790.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":461.83,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.67,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2510.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3313.78,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3006.4,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3174.82,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":460.63,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":2936.05,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3351.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.48,"methodology":"other"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3210.8,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":542.91,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":435.44,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":456.32,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4578.46,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1479.49,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2740.19,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1339.74,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":499.61,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.17,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.14,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4294.62,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3183.2,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4537.9,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":4335.45,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":350.79,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":541.26,"methodology":"other"},{"payer_name":"Conifer","plan_name":"Capitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2510.0,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":2790.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"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":2956.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4133.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2350.04,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1019.41,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":817.82,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":635.62,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":1563.4,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":545.98,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":1397.93,"methodology":"other"},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – 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":489.14,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2949.78,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":2472.7,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":5181.95,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3063.68,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.97,"methodology":"other"},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2399.18,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":456.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":142.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1192.8,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":63.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":350.79,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":498.94,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":159.60,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":480.06,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":350.79,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":746.38,"methodology":"other"},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.54,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":775.52,"methodology":"other"},{"payer_name":"Rady Childrens","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3799.7,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1098.96,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":46.00,"estimated_amount":507.24,"methodology":"percent of total billed charges"},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"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":2132.7,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":346.58,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.26,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":506.84,"methodology":"other"},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3228.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.77,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1389.95,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":352.06,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1750.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1452.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1452.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1506.26,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1650.09,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":356.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":87.01,"maximum":16211.45,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":866.86,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":2790.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":854.74,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":945.39,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2510.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3710.92,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3486.40,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3606.4,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":955.43,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3380.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4158.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3519.3,"methodology":"other"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.0,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":819.30,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":833.42,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":919.47,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7837.48,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":4147.07,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6717.47,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":754.5,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1057.28,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":822.28,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":812.33,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5620.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2426.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5742.0,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":5742.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":875.42,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":963.68,"methodology":"other"},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.17,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":2790.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"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":3103.1,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4458.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":4835.89,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1923.92,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1744.9,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":3132.3,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1257.51,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":4215.14,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7518.45,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":7656.5,"methodology":"other"},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1237.27,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6815.56,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":794.41,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":848.59,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":337.25,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2721.36,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":87.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":791.42,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":544.22,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":169.73,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":822.72,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":831.42,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2038.7,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":1122.72,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":3318.59,"methodology":"other"},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"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":1262.52,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":809.12,"methodology":"other"},{"payer_name":"Sharp Pos","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16211.45,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":996.22,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4473.71,"methodology":"other"},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4321.04,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":832.93,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2735.81,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":855.76,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3650.73,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3826.60,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3826.60,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6854.72,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3587.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3944.29,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":744.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":155.03,"maximum":15663.12,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":904.71,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":2790.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1042.78,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1334.68,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2510.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3877.62,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3266.11,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3578.90,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":1194.67,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3018.5,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4258.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5315.50,"methodology":"other"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4408.0,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1176.19,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":1301.77,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1137.41,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7074.16,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":4466.52,"methodology":"other"},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15663.12,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6731.77,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2072.78,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1437.20,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1087.37,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1230.59,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5620.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2515.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5742.0,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":5742.0,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2776.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1097.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1038.62,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":2790.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4358.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":5324.54,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":3915.82,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1996.46,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":1377.89,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":4535.98,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1470.35,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":5748.36,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":800.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6717.64,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":6300.96,"methodology":"other"},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.69,"methodology":"other"},{"payer_name":"Healthnet Pos","plan_name":"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":6805.04,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6093.1,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.37,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1329.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":526.72,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3770.16,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":155.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1047.28,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":912.56,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":441.49,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":1081.92,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1039.33,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1936.95,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":2780.08,"methodology":"other"},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.22,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":2026.59,"methodology":"other"},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"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":12939.95,"methodology":"other"},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2198.01,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":1300.87,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1134.27,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10194.1,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1153.98,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1271.63,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1218.35,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3477.99,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3488.34,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3488.34,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3597.66,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3747.87,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3533.62,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1055.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":115.87,"maximum":23160.98,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1108.71,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1715.26,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4233.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1954.38,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2545.59,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":1964.8,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3330.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4333.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18335.45,"methodology":"other"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1350.78,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":1722.92,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1795.27,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":3331.05,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10774.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":2672.34,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1774.44,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5620.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3198.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6020.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2180.83,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4358.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":9718.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":2321.84,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":7742.51,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":2746.02,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":14342.88,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":8839.72,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":7743.0,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7743.0,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1700.65,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1891.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":839.52,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":7959.22,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":115.87,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1707.59,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1500.0,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1776.94,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8764.7,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":1778.06,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":8388.51,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":1758.63,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1108.71,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2004.36,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1842.93,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":7812.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7812.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":7813.07,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16146.22,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1808.76,"methodology":"other"},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23160.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"minimum":24.0,"maximum":99581.9,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6504.66,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":25603.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":99498.65,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10882.82,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":47437.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3809.31,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99581.9,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4358.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3206.33,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4081.2,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4408.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60998.64,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":6298.14,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10774.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":3241.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86810.94,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5606.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45465.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":3880.1,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":24.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":26202.94,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":8788.11,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":5239.06,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":44487.56,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":48670.56,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":60275.18,"methodology":"other"},{"payer_name":"Healthnet Pos","plan_name":"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":58654.39,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3466.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":2946.71,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":9793.01,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3350.91,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":363.59,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":3875.15,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":43266.34,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":90.0,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3478.48,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3241.12,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":3748.22,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":23238.4,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23238.4,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47355.04,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":21291.82,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42091.54,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2383.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":34.1,"maximum":2790.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":447.4,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":285.95,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":446.4,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":514.01,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1903.77,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1055.60,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":447.22,"methodology":"other"},{"payer_name":"Calviva","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.63,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1850.1,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":447.22,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":427.23,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1869.16,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":348.82,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":454.49,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":355.98,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1181.67,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":34.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":447.22,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":256.31,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":446.81,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":812.09,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.49,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.14,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":995.36,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":995.36,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":34.1,"maximum":6423.23,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3296.4,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6423.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":978.9,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3167.21,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4234.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":839.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":2790.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":2885.24,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2831.05,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2132.06,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":34.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":691.31,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":208.6,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":499.52,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":852.71,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.68,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":498.2,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":757.27,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1844.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":544.36,"maximum":2510.0,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1090.87,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2510.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1656.74,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1829.10,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":686.93,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":544.36,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":774.81,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1318.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":4.74,"maximum":5945.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2286.24,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":231.44,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2364.79,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":100.18,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1376.68,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5945.23,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"minimum":469.19,"maximum":4577.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4402.05,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":469.19,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4577.69,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":968.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"minimum":3615.02,"maximum":3615.02,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":3615.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":12.91,"maximum":9161.50,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1007.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3183.25,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":869.16,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.1,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9161.50,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7833.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":883.37,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1735.8,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4411.78,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1137.84,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3863.31,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":850.72,"methodology":"other"},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":970.36,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1536.27,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3244.78,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":12.91,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":490.23,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":700.67,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":865.0,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":497.39,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1007.28,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":879.07,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":876.11,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1007.28,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1007.28,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5247.49,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1245.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":6.68,"maximum":23068.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3372.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":3083.33,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5016.23,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2283.95,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10899.19,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5701.78,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":12277.32,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10309.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1985.18,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8948.85,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4494.28,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":2767.06,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7612.98,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9743.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2009.51,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":790.20,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":2025.69,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3851.51,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":23068.86,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1993.28,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":675.67,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":2025.74,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2025.69,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2017.51,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":2453.78,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3311.74,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3311.74,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3074.23,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":688.68,"maximum":19597.22,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3550.26,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9356.78,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3786.46,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11962.29,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10965.6,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11634.56,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12695.36,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10655.93,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":3493.46,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3563.79,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19597.22,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":688.68,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":2782.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3493.46,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1788.40,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3571.47,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5369.44,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15102.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":1629.53,"maximum":13108.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9183.42,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10327.2,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13108.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1629.53,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":4791.74,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9581.78,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6325.99,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7989.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":9036.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9036.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":9046.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"minimum":1161.71,"maximum":84797.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":24652.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10327.2,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1657.24,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1161.71,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":8017.31,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":84797.84,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":84797.84,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"minimum":4000.0,"maximum":4000.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"minimum":11717.24,"maximum":11717.24,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":11717.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":34.1,"maximum":1353.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1353.53,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":85.41,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":34.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":892.31,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":156.54,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":389.94,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.0,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":648.97,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":558.45,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":618.56,"maximum":38394.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8786.52,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38394.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2147.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":618.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":43078.37,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7835.06,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.81,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1970.43,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7651.92,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12759.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1969.93,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4704.2,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1995.31,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8232.76,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":3151.89,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7743.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7743.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2008.09,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":5875.2,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2000.94,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":2005.55,"methodology":"other"},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2336.18,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1999.82,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1996.11,"methodology":"other"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43078.37,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2033.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":2.14,"maximum":20521.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5433.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8409.79,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4558.38,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3963.33,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10523.85,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3969.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":698.49,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20521.04,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4047.15,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3979.5,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":959.52,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3965.33,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13293.63,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":4042.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":3.77,"maximum":97988.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10725.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15339.46,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8867.71,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12706.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8759.76,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6529.5,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":22682.12,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29492.86,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3372.5,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":41575.54,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":8931.59,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":672.28,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":3965.4,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":31224.92,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":13781.14,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":7222.70,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":33724.64,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":8792.4,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1686.67,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":5291.61,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12875.81,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":9078.32,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8938.53,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8765.66,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":12458.94,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":97988.51,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":28510.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":28510.76,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":21618.82,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21479.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":5.67,"maximum":45327.25,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16665.47,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13200.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17567.04,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":21343.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16233.44,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16219.23,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16604.36,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12536.32,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11419.21,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":7228.8,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12659.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16238.86,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":28576.85,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32233.12,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":16580.93,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45327.25,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":26774.15,"methodology":"percent of total billed charges"},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1717.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16247.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1021.22,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":36983.72,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":35630.29,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5.67,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16243.53,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3295.81,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":16410.98,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18622.45,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":16588.66,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16554.9,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16121.18,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":16597.44,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":25484.20,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":29639.98,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":29639.98,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":36541.71,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24989.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":1213.83,"maximum":51439.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26805.2,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11804.06,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22818.83,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51439.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1213.83,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2408.09,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":23180.01,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":41750.55,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23339.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23118.28,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":23121.9,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":47519.06,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":527.47,"maximum":14587.68,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11011.00,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":553.99,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14587.68,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1262.46,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":4613.8,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2201.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2147.79,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":527.47,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":675.86,"maximum":12909.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8619.78,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":4604.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":675.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1676.0,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4590.95,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1986.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6385.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":110347.86,"maximum":110347.86,"setting":"outpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":110347.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":20.44,"maximum":2777.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2777.14,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":872.89,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":772.34,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1504.68,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":20.44,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":335.8,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":177.42,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":872.07,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2355.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2355.13,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":175.37,"maximum":6134.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2577.88,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4987.5,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5237.12,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5417.3,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4279.36,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2013.76,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3097.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6134.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":362.36,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2017.35,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2301.16,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1968.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":298.93,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1942.22,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":175.37,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1962.29,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1562.79,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2361.06,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2361.06,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1610.44,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":15.66,"maximum":110865.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2237.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15242.64,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3916.56,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12139.23,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":9036.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12659.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7736.86,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7893.27,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":5935.38,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3910.86,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9654.2,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":10173.46,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13411.1,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":608.22,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":12909.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7750.98,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3982.55,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":1489.71,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":110865.16,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3935.22,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":563.16,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3902.9,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5147.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":4523.56,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4523.56,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12955.54,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":9492.4,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"minimum":846.62,"maximum":76080.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23778.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6738.11,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6868.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":76080.76,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6758.58,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":846.62,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6866.07,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6756.21,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1654.78,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6731.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":719.23,"maximum":23588.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10770.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23105.46,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4012.03,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4005.03,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17996.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17996.01,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17996.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4005.03,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":10887.86,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9914.81,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":4020.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":4005.66,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":23588.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":19446.01,"methodology":"other"},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1132.67,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2147.96,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":719.23,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4012.59,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1500.0,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":4192.75,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2461.75,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4004.06,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":15242.86,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"minimum":2039.47,"maximum":36074.42,"setting":"outpatient","payers_information":[{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":36074.42,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2039.47,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7128.44,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7555.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"minimum":592.65,"maximum":96118.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14481.09,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12359.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":13592.84,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13475.32,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13576.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":14139.89,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":791.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":14154.66,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":592.65,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":14178.78,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10602.98,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14121.15,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7164.51,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":34100.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":34100.13,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":96118.2,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"minimum":143.4,"maximum":22393.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7175.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21935.08,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":17847.19,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":676.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":22393.01,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22359.5,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":143.4,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"minimum":1632.0,"maximum":9752.78,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":1632.0,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9752.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"minimum":15.02,"maximum":112141.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1836.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29157.08,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30547.33,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":7228.8,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75689.5,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":56628.30,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80126.99,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30547.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3430.28,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112141.82,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15.02,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":29113.71,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28985.28,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29088.08,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":33616.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":66532.57,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":66532.57,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":55070.78,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"minimum":413.1,"maximum":12572.25,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9100.45,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12572.25,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":413.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":10338.67,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10310.16,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5855.8,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5855.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"minimum":1725.18,"maximum":20756.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15037.19,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":13975.21,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13031.3,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1725.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13064.82,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13033.05,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":20756.65,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20756.65,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"minimum":11286.59,"maximum":23783.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23753.73,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11286.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":23783.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"minimum":28861.92,"maximum":28894.55,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":28894.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28861.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"minimum":350.0,"maximum":39927.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2780.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1654.0,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39927.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":5.64,"maximum":4153.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":901.09,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4049.35,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":4036.45,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":885.94,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4153.55,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2008.9,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1218.86,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.05,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2218.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2247.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":904.77,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":2445.29,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3017.33,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1658.11,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5.64,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":904.77,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":789.4,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1771.88,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1808.04,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1158.34,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":980.34,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1412.57,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":146.17,"maximum":12809.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3709.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4706.42,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1883.16,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10817.45,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12809.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6848.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1191.26,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6342.84,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":4035.44,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1980.03,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1114.47,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6214.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7762.40,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1318.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":362.41,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":4280.8,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":6198.01,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1755.51,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10945.53,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1930.85,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":4383.54,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":146.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1172.2,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":290.68,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1742.14,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1169.52,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1144.86,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1291.82,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":10468.2,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10468.2,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3496.21,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":1.01,"maximum":7190.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3215.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2508.64,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7164.35,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7190.51,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2873.47,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5069.75,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2339.41,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":513.41,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2546.1,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1.01,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2339.41,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":626.96,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":2371.75,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2330.91,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5741.42,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5741.42,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"minimum":923.86,"maximum":4692.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4692.83,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":923.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":966.81,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":3062.26,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":3.56,"maximum":10698.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2510.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9807.98,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":10698.15,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4305.77,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1123.66,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":629.08,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1795.55,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1123.66,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":710.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1623.82,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":271.02,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2396.44,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":6035.47,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6035.47,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1836.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":16.92,"maximum":59107.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4871.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3555.84,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2051.9,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1999.9,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10177.33,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3482.24,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":3221.30,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4632.31,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":3947.57,"methodology":"other"},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – 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":1444.93,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6878.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2092.16,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":509.58,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":3483.18,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":59107.7,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16.92,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1449.35,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":449.74,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":2211.25,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1648.75,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2722.79,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":20286.84,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20286.84,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":6067.0,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"minimum":701.63,"maximum":25765.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2352.66,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11207.36,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":25765.71,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":701.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"minimum":1424.17,"maximum":12909.0,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1424.17,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":12566.33,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12566.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":312.54,"maximum":51998.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4975.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12016.45,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4243.17,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7540.1,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13133.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4412.28,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11165.84,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":4394.34,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":38987.41,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":704.41,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":11238.81,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4404.18,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":312.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":4412.28,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4513.12,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":6635.01,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6635.01,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":51998.4,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":3.77,"maximum":70087.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12563.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13292.34,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":5338.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7269.85,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11438.53,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":13457.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12559.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7065.03,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25409.08,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":17111.46,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21572.35,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":7072.03,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7065.03,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":21306.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30507.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":7294.53,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":150.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":11534.74,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":11174.28,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":37474.5,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":45296.66,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":3.77,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":7093.86,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1500.0,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12097.98,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":35278.17,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7209.21,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7065.23,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70087.56,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":7172.98,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":7209.21,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":17791.94,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17791.94,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":22068.74,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15750.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"minimum":6.36,"maximum":50224.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17237.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29858.74,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.0,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33668.87,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12899.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12659.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12604.08,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":19383.42,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37271.92,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38546.31,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50224.2,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":13016.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1162.18,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":9594.9,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":33015.06,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":49780.50,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":6.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":12636.72,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1390.20,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13185.6,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":27255.92,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12861.31,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12604.09,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35050.14,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":35125.46,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":35125.46,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":42352.04,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35245.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"minimum":302.72,"maximum":3006.0,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3006.0,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":304.08,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":361.0,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":302.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":316.35,"maximum":834.52,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":316.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":834.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":16.48,"maximum":13707.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6876.76,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5043.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13707.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7536.22,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5364.29,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":2561.19,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2602.84,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2527.46,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":485.04,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":16.48,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2561.19,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2250.00,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4530.83,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":8116.79,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":82.94,"maximum":14533.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.94,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4910.9,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":12584.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7930.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4294.61,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10214.87,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":375.04,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4286.03,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6505.80,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4268.61,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":14533.56,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14533.56,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":57.06,"maximum":19001.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14739.90,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3815.52,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12703.40,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12909.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Hmo","plan_name":"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":12486.15,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13458.16,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":6342.71,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19001.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":685.88,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9205.97,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":57.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6355.9,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6335.71,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":6459.25,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":14335.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14335.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":16750.89,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"minimum":55684.89,"maximum":55684.89,"setting":"outpatient","payers_information":[{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":55684.89,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"minimum":11.98,"maximum":6365.55,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4508.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2154.50,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":2351.43,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1509.23,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2321.76,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11.98,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2425.99,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":230.51,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":6365.55,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1041.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":26.32,"maximum":3279.15,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.53,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":634.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":1232.96,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1232.96,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":1232.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3279.15,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3279.15,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":293.95,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":224.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":230.05,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":861.16,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1905.19,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1213.29,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1934.7,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1934.7,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":1934.7,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":153.02,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":1468.36,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1774.02,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":379.18,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":385.9,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":230.05,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2121.62,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2121.62,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":769.32,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":26.32,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":121.77,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.88,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":54.18,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":230.05,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":151.73,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":286.32,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":255.61,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":224.07,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":224.07,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1207.05,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1184.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"minimum":46.40,"maximum":4605.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":46.40,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4605.3,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":587.71,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":595.49,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":602.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"minimum":314.22,"maximum":391.8,"setting":"outpatient","payers_information":[{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":391.8,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":314.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"minimum":20.08,"maximum":15755.35,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1325.52,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9492.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4019.40,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2090.8,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10369.06,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":8586.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12534.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":8556.99,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7558.4,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11347.63,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":667.06,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":9594.9,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":13350.93,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":6262.93,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":11203.35,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":15755.35,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":20.08,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3843.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1078.33,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3873.58,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":937.81,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3906.18,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3828.06,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":10869.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10869.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":10286.19,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"minimum":4.74,"maximum":13514.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5533.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8382.34,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":12534.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12019.42,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2800.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":760.57,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":9632.58,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":10860.32,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":4.74,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6115.14,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":901.7,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4665.72,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":13115.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":13115.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":13514.78,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"minimum":1140.86,"maximum":13823.18,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12909.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1140.86,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5458.72,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1607.6,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13823.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":44.94,"maximum":33737.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33737.12,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2438.57,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":3594.8,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9962.73,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":2373.78,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":654.32,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":44.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1428.13,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":830.48,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2364.14,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":9701.19,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":9701.19,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"minimum":840.36,"maximum":22473.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22473.4,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":840.36,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4910.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":126.19,"maximum":6159.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":441.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1091.04,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":377.82,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5589.6,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6159.21,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5742.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":714.55,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1126.68,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":979.88,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":364.14,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":126.19,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":936.3,"methodology":"other"},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.9,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":474.53,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":441.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":237.41,"maximum":36336.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":804.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1889.58,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":847.76,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4770.49,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4730.2,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1293.48,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":3032.16,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2871.71,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":846.76,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":849.26,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":873.60,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":347.21,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2433.54,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1549.22,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3313.81,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":36336.88,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2235.95,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":4064.64,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":850.22,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":237.41,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":1394.75,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1176.63,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":2528.75,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":846.76,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1992.32,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1850.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1850.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1737.59,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2349.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":437.41,"maximum":25064.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25064.92,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7010.41,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1680.31,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2140.64,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1680.92,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":437.41,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2713.21,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1674.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"minimum":872.28,"maximum":872.28,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":872.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"minimum":1632.0,"maximum":29523.66,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29523.66,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1632.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Implantation of Drug Infusion Device","code_information":[{"code":"5471","type":"APC"}],"standard_charges":[{"minimum":1632.0,"maximum":25113.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25113.71,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":21926.27,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1632.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":18.14,"maximum":5586.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":107.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.58,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":183.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.62,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.48,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":628.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1594.7,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":220.53,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.72,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":340.99,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.67,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":984.06,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3165.75,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":103.9,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":1463.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1108.68,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":158.39,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":470.72,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":30.79,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":224.47,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":180.03,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":657.78,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":18.14,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":100.55,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":127.96,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":198.63,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":220.18,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.42,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":252.98,"methodology":"other"},{"payer_name":"Rady Childrens","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- 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":438.82,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":24.8,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":224.47,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":109.65,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":26.77,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":25.51,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1097.2,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":551.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":551.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":161.75,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1578.42,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":318.72,"methodology":"other"},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5586.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":67.59,"maximum":4342.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":123.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":966.67,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1138.21,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":1138.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":498.88,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":804.92,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":157.96,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":123.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":123.62,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.61,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1758.77,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1518.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4342.0,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1187.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":957.53,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1786.02,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":1786.02,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":132.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1637.68,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":209.2,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":2808.03,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":209.44,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":186.18,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.03,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":157.96,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1958.57,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":1074.82,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1598.1,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":67.59,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":132.96,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":172.12,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":243.05,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":454.08,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":78.03,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":123.62,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":137.36,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.87,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":123.62,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":136.24,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":123.62,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":123.62,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1114.29,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1093.16,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3174.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":80.43,"maximum":8081.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":398.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":985.03,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":985.03,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":985.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.79,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.89,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":850.5,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":353.2,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":314.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":275.54,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.62,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":2230.72,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1522.07,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":302.22,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":301.04,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8081.71,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2911.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1552.2,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1937.8,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":1545.65,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":452.37,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":1864.34,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":545.88,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":476.05,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":417.09,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":276.42,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":1745.83,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":497.04,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1694.98,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1833.82,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":80.43,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":301.26,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":207.80,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":521.81,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":302.22,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":640.88,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":276.42,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.16,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":300.72,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":276.42,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":312.82,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1572.78,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":337.79,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":337.79,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":946.04,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":945.99,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4272.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":127.15,"maximum":10537.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":620.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2044.67,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.29,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":683.54,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1204.23,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":753.87,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2642.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.49,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":620.35,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5088.35,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":678.25,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3143.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":685.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":381.54,"methodology":"other"},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":627.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":1068.38,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":620.35,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":620.35,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":675.49,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":10537.8,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":127.15,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":678.25,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":750.0,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":815.7,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":627.0,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":620.35,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.74,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":627.0,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":834.44,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":792.68,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":792.68,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2054.27,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1498.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":77.55,"maximum":4337.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":117.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":407.53,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2266.57,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.56,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1277.75,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1376.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":82.6,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":126.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":220.6,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.48,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":2098.63,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3147.56,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":222.57,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4337.98,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":225.89,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Conifer","plan_name":"Capitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.6,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":3949.41,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":315.55,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":189.25,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":303.41,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":77.55,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":222.57,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":541.09,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":224.97,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":220.6,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":229.56,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203.04,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":220.7,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":206.6,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":166.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":166.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":962.58,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":326.21,"maximum":16053.4,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":836.99,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":422.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":2203.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.64,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":558.48,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1497.18,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2539.34,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2844.80,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":536.94,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2328.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3028.46,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":422.69,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.53,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1497.18,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":7381.77,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5167.62,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":954.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7216.96,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4592.88,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":4684.14,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":472.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4458.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":4415.42,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1862.62,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":703.34,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":7743.0,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.43,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":556.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2890.45,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":326.21,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":446.51,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":567.96,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":448.56,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2087.88,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":422.79,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7169.08,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":920.83,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":423.14,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":957.26,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2756.01,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":857.65,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":857.65,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2687.83,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2699.64,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16053.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":81.25,"maximum":984.39,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":300.52,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":984.39,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":81.25,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":983.78,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":98.84,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":104.95,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":104.95,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":79.24,"maximum":5709.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":461.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1811.89,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":1741.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":505.64,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.09,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":463.79,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":505.01,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":839.09,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2625.66,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2549.52,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":507.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":848.52,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2505.67,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":798.75,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":1566.19,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":79.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":103.07,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":514.55,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":461.65,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2573.44,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":501.07,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":463.79,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":463.79,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":5709.42,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":306.82,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":750.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":134.76,"maximum":1533.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":607.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1330.34,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":670.68,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":576.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":786.52,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":639.63,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1482.95,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1533.27,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1217.62,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":134.76,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":513.52,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":1166.88,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1086.18,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":720.05,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":607.8,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":771.34,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":96.17,"maximum":4805.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1614.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1988.32,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":1778.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1738.67,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2414.16,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1009.87,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2308.82,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1611.16,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1184.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1774.15,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1738.67,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1052.51,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":1492.87,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3052.08,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1381.08,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":1917.13,"methodology":"other"},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – 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":2123.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2871.38,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2883.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1745.76,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1098.68,"methodology":"other"},{"payer_name":"Conifer","plan_name":"Capitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1653.86,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":2947.02,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":2035.79,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4805.14,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":96.17,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1632.2,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":750.0,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1596.74,"methodology":"other"},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1508.11,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":1596.74,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2118.79,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1684.52,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1596.74,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":2783.06,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":715.56,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":715.56,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1864.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1798.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"minimum":104.27,"maximum":5436.96,"setting":"outpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":104.27,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":5436.96,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":597.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"minimum":190.07,"maximum":190.07,"setting":"outpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":190.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Radiation Therapy","code_information":[{"code":"5621","type":"APC"}],"standard_charges":[{"minimum":2962.54,"maximum":6705.86,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2962.54,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3408.34,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":6705.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6705.86,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"minimum":61.97,"maximum":4443.81,"setting":"outpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":61.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4443.81,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":271.24,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1830.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"minimum":681.03,"maximum":2304.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":681.03,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":928.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2304.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"minimum":15905.94,"maximum":15905.94,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":15905.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":13.58,"maximum":413.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":32.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.6,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":87.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.53,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.94,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":333.88,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":250.41,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":74.44,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":183.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.02,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185.29,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":73.84,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.99,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.91,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":98.91,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":137.03,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":180.98,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"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":333.88,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":166.94,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":41.86,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":47.17,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.04,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":66.78,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":13.58,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":105.23,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.05,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":42.58,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":37.99,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":58.53,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":61.45,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":61.45,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":58.25,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":5.69,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":293.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.45,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.38,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.01,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":323.01,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":452.38,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.38,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.07,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":320.96,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":396.44,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.01,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":308.84,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5.69,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":210.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":179.73,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":209.14,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.2,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":293.0,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":157.88,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.15,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":247.88,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":32.46,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":336.84,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":336.84,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":156.52,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":93.16,"maximum":2212.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":651.58,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2212.01,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":405.96,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.43,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":370.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":585.05,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":170.14,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1300.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2151.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":433.17,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":117.09,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":503.62,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":133.44,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":445.84,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":557.8,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":764.72,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":449.11,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":1440.09,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":621.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":621.43,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":107.18,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":93.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"minimum":291.9,"maximum":882.38,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":744.36,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":865.34,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":291.9,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":364.86,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":882.38,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":634.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"minimum":13.56,"maximum":13707.0,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13707.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3519.7,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":7089.3,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":13.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":112.17,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":905.66,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":666.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":2.54,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":339.76,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86.61,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":372.84,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":302.68,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":316.43,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":2.54,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":209.60,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":160.08,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":347.7,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":408.52,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":408.52,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":15.72,"maximum":5537.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":793.6,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":636.68,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":675.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.95,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.22,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1043.74,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":833.16,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1634.36,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":300.45,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":926.13,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.8,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.44,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1880.58,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":5537.96,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2285.36,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":975.21,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.35,"methodology":"other"},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.5,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3883.81,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":581.98,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":3354.77,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":482.84,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":414.94,"methodology":"other"},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":800.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2567.27,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":472.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":682.32,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1440.75,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":15.72,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":263.42,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":269.10,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":647.33,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":267.53,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":415.42,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":432.96,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.45,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1441.89,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2664.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2664.64,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2718.48,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3689.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":714.24,"maximum":31302.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":714.24,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6675.64,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":6135.17,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31302.72,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":761.51,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":786.38,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1687.49,"methodology":"other"},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"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":3280.24,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2328.23,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":975.78,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":17166.9,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":17166.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":195.62,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":195.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":124.26,"maximum":2843.4,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":392.17,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":354.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.75,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.75,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1575.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1368.31,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":608.35,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":385.9,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":254.44,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":691.42,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":613.27,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":451.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":385.9,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":124.26,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.43,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":356.09,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":387.75,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":352.95,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":356.09,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":375.95,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.95,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2843.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":292.34,"maximum":2540.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2540.14,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":754.73,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":657.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":292.34,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":661.18,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":656.29,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":656.29,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":17.53,"maximum":133.1,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.1,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.67,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":27.53,"methodology":"percent of total billed charges"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":26.86,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":33.58,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":17.53,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":55.12,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":55.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":73.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":195.32,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":195.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":147.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":104.76,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":69.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":11.32,"maximum":7048.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":532.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.48,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.09,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.89,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7048.28,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":485.05,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":69.78,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":89.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.89,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":169.34,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.47,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":75.2,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":248.97,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11.32,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":74.26,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":317.63,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":104.08,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.44,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":148.16,"methodology":"other"},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3441.83,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.9,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":101.31,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":262.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":262.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":308.93,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":9.62,"maximum":3881.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":148.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.46,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":519.95,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2220.34,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.6,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1181.85,"methodology":"percent of total billed charges"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":534.6,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1314.73,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":692.87,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":160.5,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":800.0,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.41,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":3881.77,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":9.62,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":157.05,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":214.9,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":682.96,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":183.22,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.51,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":275.57,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":201.66,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":186.52,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":186.52,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":520.61,"maximum":2823.21,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":785.52,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1362.39,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":629.68,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":520.61,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":2823.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":731.84,"maximum":7067.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":731.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":2790.0,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2790.0,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":814.83,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4333.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1727.8,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":807.53,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":3213.81,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3047.52,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.9,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7067.82,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":800.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":911.6,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":4358.0,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1449.86,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3668.98,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":1922.48,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":4142.60,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":818.16,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":4707.55,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":814.84,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":748.72,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1856.43,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":244.16,"maximum":1200.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":254.3,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":244.16,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":260.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":2764.58,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2764.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"minimum":65.38,"maximum":30772.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5520.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4229.02,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":3882.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":198.05,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.02,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1192.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1108.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2758.0,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":451.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":451.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":402.84,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":200.07,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1616.0,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6966.71,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":200.88,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":716.96,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5199.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2235.9,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":1009.33,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":196.02,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"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":451.0,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":4464.9,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":1197.71,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":5940.14,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":308.78,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":20955.3,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7148.64,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":12168.92,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":3833.95,"methodology":"percent of total billed charges"},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12680.56,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6835.58,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":200.88,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":219.71,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":65.38,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":200.57,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":200.57,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":6858.52,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":6858.52,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":524.19,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.93,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30772.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infliximab not biosimil 10mg","code_information":[{"code":"7043","type":"APC"}],"standard_charges":[{"minimum":474.99,"maximum":27107.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1874.24,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2005.50,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1569.91,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":27107.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27107.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21594.9,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":474.99,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Alteplase recombinant","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"minimum":222.54,"maximum":2000.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":222.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tenecteplase injection","code_information":[{"code":"9002","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, inclisiran, 1 mg","code_information":[{"code":"9004","type":"APC"}],"standard_charges":[{"minimum":3540.54,"maximum":3540.54,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":3540.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj risankizumab-rzaa?1 mg","code_information":[{"code":"9013","type":"APC"}],"standard_charges":[{"minimum":10202.54,"maximum":85657.85,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10202.54,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85657.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj glucagon hcl, fresenius","code_information":[{"code":"9025","type":"APC"}],"standard_charges":[{"minimum":589.16,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":589.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj nivol relatlimab 3mg/1mg","code_information":[{"code":"9057","type":"APC"}],"standard_charges":[{"minimum":31404.24,"maximum":36780.9,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":36780.9,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31404.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, Fulvestrant","code_information":[{"code":"9120","type":"APC"}],"standard_charges":[{"minimum":735.8,"maximum":735.8,"setting":"outpatient","payers_information":[{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":735.8,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":735.8,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Risperidone, long acting","code_information":[{"code":"9125","type":"APC"}],"standard_charges":[{"minimum":14662.1,"maximum":14662.1,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":14662.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, Ado-trastuzumab Emt 1mg","code_information":[{"code":"9131","type":"APC"}],"standard_charges":[{"minimum":38034.48,"maximum":38034.48,"setting":"outpatient","payers_information":[{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":38034.48,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":38034.48,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":348.54,"maximum":7147.85,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2996.56,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3483.82,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5304.08,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":546.1,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":653.23,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":348.54,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":539.63,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":7147.85,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":2546.86,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1476.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj acetaminophen -fresenius","code_information":[{"code":"9143","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, lecanemab-irmb, 1 mg","code_information":[{"code":"9157","type":"APC"}],"standard_charges":[{"minimum":526.84,"maximum":3207.36,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":3207.36,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":1769.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":526.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, acetaminophen (b braun)","code_information":[{"code":"9160","type":"APC"}],"standard_charges":[{"minimum":239.76,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":239.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., rituximab, 10 mg","code_information":[{"code":"9186","type":"APC"}],"standard_charges":[{"minimum":40.20,"maximum":90624.12,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90624.12,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":934.15,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":9052.46,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":40.20,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3373.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":513.22,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":40847.9,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41997.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj crotalidae im f(ab')2 eq","code_information":[{"code":"9188","type":"APC"}],"standard_charges":[{"minimum":11318.52,"maximum":11318.52,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":11318.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"minimum":31654.55,"maximum":31654.55,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Hmo","plan_name":"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":31654.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, remdesivir, 1 mg","code_information":[{"code":"9200","type":"APC"}],"standard_charges":[{"minimum":1000.0,"maximum":4652.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4652.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2463.73,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":2927.96,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2673.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies ig ht&sol human im/sc","code_information":[{"code":"9201","type":"APC"}],"standard_charges":[{"minimum":892.43,"maximum":18368.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2790.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5465.75,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9749.88,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1810.8,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":18368.06,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3148.05,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":14954.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3702.81,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3305.11,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":892.43,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":7077.53,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5571.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. pemetrexed nos 10mg","code_information":[{"code":"9213","type":"APC"}],"standard_charges":[{"minimum":731.72,"maximum":6395.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":731.72,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6395.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bevacizumab injection","code_information":[{"code":"9214","type":"APC"}],"standard_charges":[{"minimum":11.88,"maximum":4290.86,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3096.49,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":11.88,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":4015.66,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":4290.86,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":3492.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cetuximab injection","code_information":[{"code":"9215","type":"APC"}],"standard_charges":[{"minimum":6044.64,"maximum":11697.59,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11697.59,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":6044.64,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":9338.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Procainamide hcl injection","code_information":[{"code":"9219","type":"APC"}],"standard_charges":[{"minimum":4097.76,"maximum":4097.76,"setting":"outpatient","payers_information":[{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":4097.76,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Abatacept injection","code_information":[{"code":"9230","type":"APC"}],"standard_charges":[{"minimum":1486.94,"maximum":6963.33,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2467.65,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":6963.33,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1486.94,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3495.64,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3195.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, invega sustenna, 1 mg","code_information":[{"code":"9255","type":"APC"}],"standard_charges":[{"minimum":104.44,"maximum":11632.9,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.44,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11632.9,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1176.8,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2453.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tocilizumab injection","code_information":[{"code":"9264","type":"APC"}],"standard_charges":[{"minimum":250.0,"maximum":6992.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2106.63,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1046.62,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":250.0,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6992.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, denosumab","code_information":[{"code":"9272","type":"APC"}],"standard_charges":[{"minimum":1675.35,"maximum":18800.20,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3358.96,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18800.20,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1675.35,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3244.16,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":3335.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, pegloticase","code_information":[{"code":"9281","type":"APC"}],"standard_charges":[{"minimum":3395.48,"maximum":3395.48,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":3395.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ipilimumab injection","code_information":[{"code":"9284","type":"APC"}],"standard_charges":[{"minimum":17313.97,"maximum":27434.02,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":17313.97,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":27434.02,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":23294.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"minimum":5.99,"maximum":5.99,"setting":"outpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":5.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., cemiplimab-rwlc, 1 mg","code_information":[{"code":"9304","type":"APC"}],"standard_charges":[{"minimum":6692.6,"maximum":90608.0,"setting":"outpatient","payers_information":[{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":32354.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":90608.0,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":6692.6,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":9526.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. romosozumab-aqqg 1 mg","code_information":[{"code":"9327","type":"APC"}],"standard_charges":[{"minimum":2391.53,"maximum":2391.53,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":2391.53,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, polatuzumab vedotin 1mg","code_information":[{"code":"9331","type":"APC"}],"standard_charges":[{"minimum":1536.57,"maximum":7458.87,"setting":"outpatient","payers_information":[{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7458.87,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":1536.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj truxima 10 mg","code_information":[{"code":"9336","type":"APC"}],"standard_charges":[{"minimum":2760.83,"maximum":39063.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":2760.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3633.01,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":5262.24,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":39063.75,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":27612.83,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27612.83,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj fam-trastu deru-nxki 1mg","code_information":[{"code":"9353","type":"APC"}],"standard_charges":[{"minimum":9121.03,"maximum":60340.31,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":9121.03,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":60340.31,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj. eptinezumab-jjmr 1 mg","code_information":[{"code":"9357","type":"APC"}],"standard_charges":[{"minimum":1598.54,"maximum":14208.12,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1598.54,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":5278.28,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1686.69,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":14208.12,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":14208.12,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj ruxience, 10 mg","code_information":[{"code":"9367","type":"APC"}],"standard_charges":[{"minimum":737.06,"maximum":2043.41,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1133.18,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":737.06,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2043.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. isatuximab-irfc 10 mg","code_information":[{"code":"9377","type":"APC"}],"standard_charges":[{"minimum":13923.63,"maximum":22957.55,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":13923.63,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":22957.55,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Daratumumab, hyaluronidase","code_information":[{"code":"9378","type":"APC"}],"standard_charges":[{"minimum":5442.12,"maximum":32561.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32561.17,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":28689.95,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":5442.12,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":9068.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj. lurbinectedin, 0.1 mg","code_information":[{"code":"9389","type":"APC"}],"standard_charges":[{"minimum":3440.94,"maximum":16659.81,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":16659.81,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3440.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pertuzu, trastuzu, 10 mg","code_information":[{"code":"9390","type":"APC"}],"standard_charges":[{"minimum":11854.31,"maximum":113535.29,"setting":"outpatient","payers_information":[{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44357.21,"methodology":"other"},{"payer_name":"Conifer","plan_name":"Capitation","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24245.19,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":11854.31,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":113535.29,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":113535.29,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj anifrolumab-fnia 1mg","code_information":[{"code":"9434","type":"APC"}],"standard_charges":[{"minimum":3820.43,"maximum":6632.14,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6632.14,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":3882.63,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":3820.43,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj pegfilgrast ex bio 0.5mg","code_information":[{"code":"9436","type":"APC"}],"standard_charges":[{"minimum":2199.24,"maximum":42080.85,"setting":"outpatient","payers_information":[{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3701.33,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":42080.85,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":2199.24,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":2796.36,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":36194.88,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":36194.88,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Injection, nivolumab","code_information":[{"code":"9453","type":"APC"}],"standard_charges":[{"minimum":3685.46,"maximum":77068.01,"setting":"outpatient","payers_information":[{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":77068.01,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":11140.18,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3685.46,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":48313.9,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":48313.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Injection, siltuximab","code_information":[{"code":"9455","type":"APC"}],"standard_charges":[{"minimum":15809.54,"maximum":26863.26,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":26863.26,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":15809.54,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Injection, mepolizumab, 1mg","code_information":[{"code":"9473","type":"APC"}],"standard_charges":[{"minimum":3081.41,"maximum":3081.41,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":3081.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, daratumumab 10 mg","code_information":[{"code":"9476","type":"APC"}],"standard_charges":[{"minimum":8868.99,"maximum":8868.99,"setting":"outpatient","payers_information":[{"payer_name":"United Health Care Hmo","plan_name":"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":8868.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection trabectedin 0.1mg","code_information":[{"code":"9480","type":"APC"}],"standard_charges":[{"minimum":8934.76,"maximum":8934.76,"setting":"outpatient","payers_information":[{"payer_name":"Medicare","plan_name":"Medicare- 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":8934.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, atezolizumab,10 mg","code_information":[{"code":"9483","type":"APC"}],"standard_charges":[{"minimum":1944.61,"maximum":13340.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1944.61,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":10959.28,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":10376.47,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":13340.26,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":13030.14,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":5428.38,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, bezlotoxumab, 10 mg","code_information":[{"code":"9490","type":"APC"}],"standard_charges":[{"minimum":4186.63,"maximum":4186.63,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":4186.63,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj., durvalumab, 10 mg","code_information":[{"code":"9492","type":"APC"}],"standard_charges":[{"minimum":10294.28,"maximum":16621.0,"setting":"outpatient","payers_information":[{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":12741.91,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":10294.28,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":16621.0,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":11761.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, ocrelizumab","code_information":[{"code":"9494","type":"APC"}],"standard_charges":[{"minimum":2354.86,"maximum":2354.86,"setting":"outpatient","payers_information":[{"payer_name":"United Health Care Hmo","plan_name":"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":2354.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"minimum":1463.25,"maximum":4515.94,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4515.94,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":2275.01,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1463.25,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3368.6,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1524.41,"methodology":"percent of total billed charges"},{"payer_name":"Medicare","plan_name":"Medicare- 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":1463.25,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":2250.0,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2798.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"minimum":210.0,"maximum":3151.02,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3143.91,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":210.0,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":3151.02,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":740.80,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1175.25,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":1943.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":8.03,"maximum":1500.0,"setting":"outpatient","payers_information":[{"payer_name":"Active Duty Military","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.21,"methodology":"other"},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":30.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – 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":160.2,"methodology":"other"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":125.45,"methodology":"other"},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":51.00,"estimated_amount":102.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.93,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63.7,"methodology":"other"},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.24,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":271.0,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":291.6,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":297.63,"methodology":"other"},{"payer_name":"Anthem","plan_name":"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":64.82,"methodology":"other"},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"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":446.64,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":27.98,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":59.34,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – 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":89.07,"methodology":"other"},{"payer_name":"Anthem Senior Hmo","plan_name":"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":53.0,"methodology":"other"},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.90,"methodology":"other"},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":883.94,"methodology":"other"},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":296.8,"methodology":"other"},{"payer_name":"Blue Shield Hmo","plan_name":"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":418.35,"methodology":"other"},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.21,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":205.14,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1200.0,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – 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":68.28,"methodology":"other"},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":55.0,"methodology":"other"},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.08,"methodology":"other"},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – 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":57.73,"methodology":"other"},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.46,"methodology":"other"},{"payer_name":"Cigna","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":241.76,"methodology":"other"},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":105.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.39,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":135.41,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":87.9,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Covered Ca Aetna","plan_name":"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":273.61,"methodology":"other"},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"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":215.81,"methodology":"other"},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"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":1500.0,"methodology":"other"},{"payer_name":"Covered Ca Health Hmo","plan_name":"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":90.75,"methodology":"other"},{"payer_name":"Covered Ca Health Ppo","plan_name":"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":37.28,"methodology":"other"},{"payer_name":"Covered Ca Kaiser","plan_name":"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":188.38,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":22.03,"methodology":"other"},{"payer_name":"Covered Ca Sharp","plan_name":"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":60.91,"methodology":"other"},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":732.71,"methodology":"other"},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":44.99,"methodology":"percent of total billed charges"},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"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":192.88,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":454.38,"methodology":"other"},{"payer_name":"Healthnet Pos","plan_name":"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":69.14,"methodology":"other"},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.52,"methodology":"other"},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.48,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – 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":158.99,"methodology":"other"},{"payer_name":"Kaiser","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":40.00,"estimated_amount":127.6,"methodology":"percent of total billed charges"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":8.03,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":57.93,"methodology":"other"},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – 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":22.03,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":118.59,"methodology":"other"},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – 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":52.13,"methodology":"other"},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – 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":93.78,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.86,"methodology":"other"},{"payer_name":"Prospect","plan_name":"Managed Care Plan- 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":96.22,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":49.88,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":46.00,"estimated_amount":34.38,"methodology":"percent of total billed charges"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":34.16,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.21,"methodology":"other"},{"payer_name":"Triwest","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.78,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":45.22,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":39.73,"methodology":"other"},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.91,"methodology":"other"},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – 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":64.27,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":89.7,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":39.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":39.5,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.92,"methodology":"other"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":66.74,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.22,"methodology":"other"},{"payer_name":"Veterans Administration","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":149.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":32.23,"maximum":1356.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":167.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":647.7,"methodology":"other"},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.35,"methodology":"other"},{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":490.0,"methodology":"other"},{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":588.0,"methodology":"percent of total billed charges"},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.63,"methodology":"other"},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1356.46,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":528.45,"methodology":"other"},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1306.60,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – 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":174.96,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":80.46,"methodology":"other"},{"payer_name":"Covered Ca Molina","plan_name":"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":409.91,"methodology":"other"},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":32.23,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":166.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":160.53,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":224.43,"methodology":"other"},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – 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":292.71,"methodology":"other"},{"payer_name":"Tricare","plan_name":"Military","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.72,"methodology":"other"},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":294.15,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":244.41,"methodology":"other"},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":893.0,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":867.14,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":867.14,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":649.36,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"minimum":43.32,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":138.38,"methodology":"other"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":43.32,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":179.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"minimum":266.82,"maximum":1064.50,"setting":"outpatient","payers_information":[{"payer_name":"Anthem Hmo","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":588.0,"methodology":"percent of total billed charges"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":716.34,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":266.82,"methodology":"other"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":37.51,"estimated_amount":1064.50,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"Hmo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":50.00,"estimated_amount":1064.50,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Anesthesia, bundled","code_information":[{"code":"N901","type":"APC"}],"standard_charges":[{"minimum":78.89,"maximum":78.89,"setting":"outpatient","payers_information":[{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":78.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":1.57,"maximum":1000.0,"setting":"outpatient","payers_information":[{"payer_name":"Anthem","plan_name":"Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22.08,"methodology":"other"},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":734.38,"methodology":"other"},{"payer_name":"Cigna Ppo","plan_name":"Ppo","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.74,"estimated_amount":335.49,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – 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":1000.0,"methodology":"other"},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – 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":265.89,"methodology":"other"},{"payer_name":"Medi-Cal","plan_name":"Medicaid -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":1.57,"methodology":"other"},{"payer_name":"Medicare","plan_name":"Medicare- 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":43.14,"methodology":"other"},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – 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":83.64,"methodology":"other"},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":67.9,"methodology":"other"},{"payer_name":"Shap Health Plan","plan_name":"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":104.21,"methodology":"other"},{"payer_name":"United Health Care Hmo","plan_name":"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":151.2,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component cha","code":"TC","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate structure, a service that is distinct because it was performed on a separate organ/structure","code":"XS","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Active Duty Military","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Epo","plan_name":"Gatekeeper – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Hmo/Pos","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Ppo","plan_name":"Non-Gatekeeper – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna Wh","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Blue Cross Priority Select","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicaid","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Medicare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior","plan_name":"Medicare Advantage Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Anthem Senior Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Blue Shield","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross Federal Employee","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Hmo Mercy Physicians","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Mcal Hmo Cpmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Promise","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Shield Senior Ppo","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Brand New Day","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"California Children Service","plan_name":"Medi-Cal","description":"The modified price is presented in the standard charge value."},{"payer_name":"Calviva","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Central Health Medicare Plan","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Hmo Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Open Access","plan_name":"Hmo/Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Scripps Med Group Risk","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Communithealth Plan Of Imperial Valley","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Community Health Group","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Conifer","plan_name":"Capitation","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Performance Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cov Ca Sharp Premier Hmo","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Aetna","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Epo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Cross Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Blue Shield Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Hmo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Health Ppo","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Kaiser","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Molina","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Covered Ca Sharp","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health Net Community Solutions, Inc","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Centene","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Community Solutions","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Hmo Salud Y Mas","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Cal","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medicare Supplement -Medigap","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Medi-Connect Scripps Coastal","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Pos","plan_name":"Pos","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Healthnet Sr Gmg Temecula","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Kaiser","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lifesharing","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health Services","plan_name":"Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medi-Cal","plan_name":"Medicaid -Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare","plan_name":"Medicare- Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medicare Hmo","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medi Connect","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Medicare","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Palomar Health-Self Insurance","plan_name":"Managed Care Plan- Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Patient Centered Community Care Va","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prospect","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady Childrens","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Rady's Children","plan_name":"Managed Care Plan- Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sec Horizon Hmo Srs","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Shap Health Plan","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Conifer Capitation Risk","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Direct Advantage Scmg Nin","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Arch","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hdhp Gmg","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Hmo Gmg Tem","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Medicare Advantage","plan_name":"Medicare Advantage Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sharp Pos","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Tricare","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Triwest","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Advantage","plan_name":"Medicare Advantage Plan – Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Hmo","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care International","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Senior","plan_name":"Medicare Managed Care Plan – Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Health Care Umr","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Harmony Hmo Gmg Temecu","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Ppo","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare Select Plus","plan_name":"Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Administration","plan_name":"Military","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veterans Evaluation Services","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wausau Com Sd","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."}]}]}