{"hospital_name":"HCA FLORIDA JFK NORTH HOSPITAL","last_updated_on":"2024-10-01","version":"2.2.0","affirmation":{"affirmation":"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.","confirm_affirmation":true},"hospital_location":["HCA FLORIDA JFK NORTH HOSPITAL"],"hospital_address":["2201 45th St, West Palm Beach, FL, 33407"],"license_information":{"hospital_license_number":"4368","state":"FL"},"standard_charge_information":[{"description":"Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples) ","code_information":[{"code":"80415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53.10,"maximum":83.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":57.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":59.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":83.84,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":69.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":59.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":59.80,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":62.60,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":55.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":55.33,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":55.65,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":53.10,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"Chorionic villus sampling, any method ","code_information":[{"code":"481","type":"RC"},{"code":"59015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Chorionic villus sampling, any method ","code_information":[{"code":"490","type":"RC"},{"code":"59015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1 karyotype, with banding ","code_information":[{"code":"88269","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164.98,"maximum":260.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":178.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":185.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":184.08,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":260.49,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":208.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":177.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":177.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":217.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":191.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":185.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":185.82,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":194.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":171.92,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":171.92,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":172.89,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":208.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":206.66,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":164.98,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":191.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":174.53,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":173.66,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; additional specialized banding technique (eg, NOR, C-banding) ","code_information":[{"code":"88283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.17,"maximum":102.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":70.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":73.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":102.90,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":82.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":69.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":69.97,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":85.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":73.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":73.40,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":76.83,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":67.91,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":67.91,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":68.30,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":82.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":81.63,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":65.17,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":68.60,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding ","code_information":[{"code":"155881","type":"CDM"},{"code":"88262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119.22,"maximum":188.23,"gross_charge":614.00,"discounted_cash":614.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":129.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":133.02,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":188.23,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":150.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":156.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":140.55,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":124.24,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":124.24,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":124.94,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":150.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":149.33,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":131.76,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":119.22,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":131.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":131.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":126.12,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"Chromotubation of oviduct, including materials ","code_information":[{"code":"360","type":"RC"},{"code":"58350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cryotherapy ","code_information":[{"code":"369","type":"RC"},{"code":"66720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cyclodialysis ","code_information":[{"code":"361","type":"RC"},{"code":"66740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cyclodialysis ","code_information":[{"code":"66740","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cyclophotocoagulation, transscleral ","code_information":[{"code":"369","type":"RC"},{"code":"66710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cyclophotocoagulation, transscleral ","code_information":[{"code":"481","type":"RC"},{"code":"66710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; cyclophotocoagulation, transscleral ","code_information":[{"code":"490","type":"RC"},{"code":"66710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ciliary body destruction; diathermy ","code_information":[{"code":"66700","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC ","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":23183.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":21218.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19010.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":23134.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":18277.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19659.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":21752.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":19103.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9105.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18732.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18732.49,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":18126.93,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20401.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":17680.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21075.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":18917.96,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18917.96,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":20216.25,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19659.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20772.66,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":19288.90,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17990.61,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19288.90,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":18917.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":20030.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23183.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15181.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":19288.90,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17619.67,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":19288.90,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":20030.78,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":20401.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19103.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":21691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17675.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":17897.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":18547.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17990.61,"methodology":"fee schedule"}]}]},{"description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age ","code_information":[{"code":"360","type":"RC"},{"code":"54161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age ","code_information":[{"code":"499","type":"RC"},{"code":"54161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Circumcision, using clamp or other device with regional dorsal penile or ring block ","code_information":[{"code":"490","type":"RC"},{"code":"54150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Circumcision, using clamp or other device with regional dorsal penile or ring block ","code_information":[{"code":"54150","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment ","code_information":[{"code":"369","type":"RC"},{"code":"61055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment ","code_information":[{"code":"481","type":"RC"},{"code":"61055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment ","code_information":[{"code":"490","type":"RC"},{"code":"61055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"61050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure) ","code_information":[{"code":"61050","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"CLAMP EXFIX LG MULTISCRW ","code_information":[{"code":"922940","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":12246.00,"discounted_cash":12246.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":2020.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":918.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2338.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":1763.42,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2204.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3061.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2694.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1591.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1016.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":881.71,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1836.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":2706.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2436.95,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9796.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1959.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2816.58,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2571.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":4163.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2816.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2081.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10409.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9184.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1138.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1591.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9796.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10409.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6123.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1653.21,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":17756.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":3490.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5510.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3098.24,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP EXFX LG 105MM ","code_information":[{"code":"927560","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"Claviculectomy; partial ","code_information":[{"code":"23120","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Claviculectomy; partial ","code_information":[{"code":"23120","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Claviculectomy; total ","code_information":[{"code":"23125","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"CLIP HMCLP 230X16X2.8 ","code_information":[{"code":"864318","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Clitoroplasty for intersex state ","code_information":[{"code":"360","type":"RC"},{"code":"56805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Clitoroplasty for intersex state ","code_information":[{"code":"499","type":"RC"},{"code":"56805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of acromioclavicular dislocation; with manipulation ","code_information":[{"code":"23545","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of acromioclavicular dislocation; without manipulation ","code_information":[{"code":"23540","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation ","code_information":[{"code":"27842","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ankle dislocation; without anesthesia ","code_information":[{"code":"27840","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ankle dislocation; without anesthesia ","code_information":[{"code":"27840","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each ","code_information":[{"code":"26742","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each ","code_information":[{"code":"26742","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each ","code_information":[{"code":"26742","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each ","code_information":[{"code":"26740","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each ","code_information":[{"code":"26740","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation ","code_information":[{"code":"27810","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation ","code_information":[{"code":"27810","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation ","code_information":[{"code":"27808","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of calcaneal fracture; with manipulation ","code_information":[{"code":"28405","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of calcaneal fracture; without manipulation ","code_information":[{"code":"28400","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid ºnavicular»); with manipulation, each bone ","code_information":[{"code":"25635","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid ºnavicular»); with manipulation, each bone ","code_information":[{"code":"25635","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid ºnavicular»); without manipulation, each bone ","code_information":[{"code":"25630","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia ","code_information":[{"code":"26675","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia ","code_information":[{"code":"26675","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia ","code_information":[{"code":"26670","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia ","code_information":[{"code":"26670","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation ","code_information":[{"code":"26645","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of coccygeal fracture ","code_information":[{"code":"27200","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger) ","code_information":[{"code":"26432","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27517","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal femoral epiphyseal separation; without manipulation ","code_information":[{"code":"27516","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal fibular fracture (lateral malleolus); without manipulation ","code_information":[{"code":"27786","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each ","code_information":[{"code":"26750","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each ","code_information":[{"code":"26750","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation ","code_information":[{"code":"25600","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation ","code_information":[{"code":"25600","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal radioulnar dislocation with manipulation ","code_information":[{"code":"25675","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation ","code_information":[{"code":"27510","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral fracture, proximal end, head; without manipulation ","code_information":[{"code":"27267","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral fracture, proximal end, neck; without manipulation ","code_information":[{"code":"27230","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral fracture, proximal end, neck; without manipulation ","code_information":[{"code":"27230","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27502","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27502","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of femoral shaft fracture, without manipulation ","code_information":[{"code":"27500","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture great toe, phalanx or phalanges; without manipulation ","code_information":[{"code":"28490","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of orbit, except blowout; with manipulation ","code_information":[{"code":"21401","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of orbit, except blowout; with manipulation ","code_information":[{"code":"21401","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of orbit, except blowout; without manipulation ","code_information":[{"code":"21400","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of orbit, except blowout; without manipulation ","code_information":[{"code":"21400","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation ","code_information":[{"code":"27825","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation ","code_information":[{"code":"27824","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation ","code_information":[{"code":"27824","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each ","code_information":[{"code":"28515","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each ","code_information":[{"code":"28510","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each ","code_information":[{"code":"28510","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of greater humeral tuberosity fracture; without manipulation ","code_information":[{"code":"23620","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of greater trochanteric fracture, without manipulation ","code_information":[{"code":"27246","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; without anesthesia ","code_information":[{"code":"27250","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; without anesthesia ","code_information":[{"code":"27250","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24577","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24577","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; without manipulation ","code_information":[{"code":"24576","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24565","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction ","code_information":[{"code":"24505","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral shaft fracture; without manipulation ","code_information":[{"code":"24500","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia ","code_information":[{"code":"26775","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia ","code_information":[{"code":"26775","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation; requiring anesthesia ","code_information":[{"code":"28665","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28660","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation ","code_information":[{"code":"27238","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of knee dislocation; requiring anesthesia ","code_information":[{"code":"27552","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of knee dislocation; without anesthesia ","code_information":[{"code":"27550","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of lunate dislocation, with manipulation ","code_information":[{"code":"25690","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of lunate dislocation, with manipulation ","code_information":[{"code":"25690","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture with interdental fixation ","code_information":[{"code":"21453","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture with interdental fixation ","code_information":[{"code":"21453","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture; with manipulation ","code_information":[{"code":"21451","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture; without manipulation ","code_information":[{"code":"21450","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture; without manipulation ","code_information":[{"code":"21450","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) ","code_information":[{"code":"21440","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27762","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of medial malleolus fracture; without manipulation ","code_information":[{"code":"27760","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, single; with manipulation, each bone ","code_information":[{"code":"26605","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, single; with manipulation, each bone ","code_information":[{"code":"26605","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, single; without manipulation, each bone ","code_information":[{"code":"26600","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone ","code_information":[{"code":"26607","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia ","code_information":[{"code":"26705","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia ","code_information":[{"code":"26705","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metatarsal fracture; with manipulation, each ","code_information":[{"code":"28475","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metatarsal fracture; without manipulation, each ","code_information":[{"code":"28470","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metatarsophalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28630","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation ","code_information":[{"code":"24620","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION ","code_information":[{"code":"21310","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of nasal septal fracture, with or without stabilization ","code_information":[{"code":"21337","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of nasal septal fracture, with or without stabilization ","code_information":[{"code":"21337","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint ","code_information":[{"code":"21421","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar dislocation; requiring anesthesia ","code_information":[{"code":"27562","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar dislocation; without anesthesia ","code_information":[{"code":"27560","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar fracture, without manipulation ","code_information":[{"code":"27520","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each ","code_information":[{"code":"26720","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia ","code_information":[{"code":"27265","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia ","code_information":[{"code":"27265","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; with manipulation ","code_information":[{"code":"27768","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; with manipulation ","code_information":[{"code":"27768","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; with manipulation ","code_information":[{"code":"27768","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; with manipulation ","code_information":[{"code":"27768","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; without manipulation ","code_information":[{"code":"27767","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27198","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; with manipulation ","code_information":[{"code":"27781","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; with manipulation ","code_information":[{"code":"27781","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; without manipulation ","code_information":[{"code":"27780","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction ","code_information":[{"code":"23605","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia ","code_information":[{"code":"27830","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; with manipulation ","code_information":[{"code":"25565","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial head or neck fracture; without manipulation ","code_information":[{"code":"24650","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) ","code_information":[{"code":"25520","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) ","code_information":[{"code":"25520","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture; with manipulation ","code_information":[{"code":"25505","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture; without manipulation ","code_information":[{"code":"25500","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation ","code_information":[{"code":"25660","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement) ","code_information":[{"code":"23575","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; without manipulation ","code_information":[{"code":"23570","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia ","code_information":[{"code":"23655","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia ","code_information":[{"code":"23655","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with manipulation; without anesthesia ","code_information":[{"code":"23650","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation ","code_information":[{"code":"23675","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; without manipulation ","code_information":[{"code":"23520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternum fracture ","code_information":[{"code":"21820","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27503","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27503","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation ","code_information":[{"code":"27501","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"24535","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation ","code_information":[{"code":"24530","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talotarsal joint dislocation; without anesthesia ","code_information":[{"code":"28570","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talus fracture; without manipulation ","code_information":[{"code":"28430","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia ","code_information":[{"code":"28545","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia ","code_information":[{"code":"28540","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28605","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28605","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia ","code_information":[{"code":"28600","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent ","code_information":[{"code":"21485","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of temporomandibular dislocation; initial or subsequent ","code_information":[{"code":"21480","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction ","code_information":[{"code":"27532","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction ","code_information":[{"code":"27532","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction ","code_information":[{"code":"27752","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation ","code_information":[{"code":"27750","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation ","code_information":[{"code":"25680","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; with manipulation ","code_information":[{"code":"27818","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; without manipulation ","code_information":[{"code":"27816","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; without manipulation ","code_information":[{"code":"27816","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); with manipulation ","code_information":[{"code":"24675","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); with manipulation ","code_information":[{"code":"24675","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); with manipulation ","code_information":[{"code":"24675","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar shaft fracture; with manipulation ","code_information":[{"code":"25535","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar styloid fracture ","code_information":[{"code":"25650","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing ","code_information":[{"code":"22310","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction ","code_information":[{"code":"22315","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"CLOSED TX SPINE PROCESS FX ","code_information":[{"code":"22305","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Closure of cystostomy (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"51880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of cystostomy (separate procedure) ","code_information":[{"code":"51880","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of esophagostomy or fistula; cervical approach ","code_information":[{"code":"43420","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of gastrostomy, surgical ","code_information":[{"code":"43870","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"360","type":"RC"},{"code":"40830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of lacrimal fistula (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"68770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by plug, each ","code_information":[{"code":"481","type":"RC"},{"code":"68761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery ","code_information":[{"code":"361","type":"RC"},{"code":"68760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery ","code_information":[{"code":"481","type":"RC"},{"code":"68760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery ","code_information":[{"code":"490","type":"RC"},{"code":"68760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"53520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; ","code_information":[{"code":"499","type":"RC"},{"code":"57310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; ","code_information":[{"code":"57310","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; ","code_information":[{"code":"57310","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; with bulbocavernosus transplant ","code_information":[{"code":"499","type":"RC"},{"code":"57311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicouterine fistula; ","code_information":[{"code":"361","type":"RC"},{"code":"51920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicouterine fistula; ","code_information":[{"code":"499","type":"RC"},{"code":"51920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula, abdominal approach ","code_information":[{"code":"360","type":"RC"},{"code":"51900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; transvesical and vaginal approach ","code_information":[{"code":"369","type":"RC"},{"code":"57330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; transvesical and vaginal approach ","code_information":[{"code":"481","type":"RC"},{"code":"57330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; vaginal approach ","code_information":[{"code":"360","type":"RC"},{"code":"57320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure postauricular fistula, mastoid (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"69700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closure salivary fistula ","code_information":[{"code":"42600","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Clotting; factor V (AcG or proaccelerin), labile factor ","code_information":[{"code":"117887","type":"CDM"},{"code":"85220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.77,"maximum":26.47,"gross_charge":120.00,"discounted_cash":120.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":26.47,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.65,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor XI (PTA) ","code_information":[{"code":"156746","type":"CDM"},{"code":"85270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.00,"maximum":26.85,"gross_charge":120.00,"discounted_cash":120.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17.72,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17.72,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.30,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17.99,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"}]}]},{"description":"Clotting; prekallikrein assay (Fletcher factor assay) ","code_information":[{"code":"85292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.98,"maximum":28.39,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":20.07,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":21.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.93,"methodology":"fee schedule"}]}]},{"description":"CNTRSNK DRL CPLNG 3MM ","code_information":[{"code":"863614","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2447.00,"discounted_cash":2447.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":403.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":183.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":352.37,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":440.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":611.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":538.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":318.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":203.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":176.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":367.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":540.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":486.95,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1957.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":391.52,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":562.81,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":513.87,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":831.98,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":562.81,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":415.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2079.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1835.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":227.57,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":318.11,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1957.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2079.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1223.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":330.35,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3548.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":697.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1101.15,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":619.09,"methodology":"percent of total billed charges"}]}]},{"description":"CNTRSNK HDLS 2.5/3.0MM ","code_information":[{"code":"932847","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4905.00,"discounted_cash":4905.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":809.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":367.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":936.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":706.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":882.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1226.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1079.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":637.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":407.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":353.16,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":735.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1084.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":976.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3924.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":784.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1128.15,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1030.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1667.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1128.15,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":833.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4169.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3678.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":637.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3924.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4169.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2452.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":662.17,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7112.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1397.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2207.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1240.96,"methodology":"percent of total billed charges"}]}]},{"description":"Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte ","code_information":[{"code":"119385","type":"CDM"},{"code":"85397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29.32,"maximum":46.29,"gross_charge":154.00,"discounted_cash":154.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":30.55,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":30.55,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":30.72,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"}]}]},{"description":"Coccygectomy, primary ","code_information":[{"code":"27080","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Cochlear device implantation, with or without mastoidectomy ","code_information":[{"code":"361","type":"RC"},{"code":"69930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":97775.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":97775.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":70179.00,"methodology":"case rate"}]}]},{"description":"Cochlear device implantation, with or without mastoidectomy ","code_information":[{"code":"69930","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":97775.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":97775.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":70179.00,"methodology":"case rate"}]}]},{"description":"Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed ","code_information":[{"code":"0402T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed ","code_information":[{"code":"0402T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified ","code_information":[{"code":"36592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":10262.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"COLON SUBMUCOSAL INJECT ","code_information":[{"code":"117276","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":6375.00,"discounted_cash":6375.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":478.13,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1147.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":529.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":459.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":956.25,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5100.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1020.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1466.25,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1466.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1083.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5418.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4781.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":592.88,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5100.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5418.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3187.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":860.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9243.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2868.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1612.88,"methodology":"percent of total billed charges"}]}]},{"description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"44388","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"44401","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with biopsy, single or multiple ","code_information":[{"code":"360","type":"RC"},{"code":"44389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with biopsy, single or multiple ","code_information":[{"code":"44389","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with control of bleeding, any method ","code_information":[{"code":"369","type":"RC"},{"code":"44391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with control of bleeding, any method ","code_information":[{"code":"44391","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"369","type":"RC"},{"code":"44408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"44408","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"44408","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with directed submucosal injection(s), any substance ","code_information":[{"code":"44404","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with endoscopic mucosal resection ","code_information":[{"code":"360","type":"RC"},{"code":"44403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with endoscopic mucosal resection ","code_information":[{"code":"44403","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures ","code_information":[{"code":"361","type":"RC"},{"code":"44406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"360","type":"RC"},{"code":"44392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"361","type":"RC"},{"code":"44394","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic balloon dilation ","code_information":[{"code":"44405","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descendi ","code_information":[{"code":"44407","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descendi ","code_information":[{"code":"44407","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45388","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"369","type":"RC"},{"code":"45398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"45398","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with biopsy, single or multiple ","code_information":[{"code":"45380","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"360","type":"RC"},{"code":"45393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with directed submucosal injection(s), any substance ","code_information":[{"code":"360","type":"RC"},{"code":"45381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"45379","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"45379","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"45385","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with transendoscopic balloon dilation ","code_information":[{"code":"361","type":"RC"},{"code":"45386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colorectal cancer screening; colonoscopy on individual at high risk ","code_information":[{"code":"481","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Colorectal cancer screening; colonoscopy on individual at high risk ","code_information":[{"code":"490","type":"RC"},{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk ","code_information":[{"code":"481","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar fracture, without manipulation ","code_information":[{"code":"27520","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar fracture, without manipulation ","code_information":[{"code":"27520","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar fracture, without manipulation ","code_information":[{"code":"27520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of patellar fracture, without manipulation ","code_information":[{"code":"27520","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each ","code_information":[{"code":"26725","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each ","code_information":[{"code":"26725","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each ","code_information":[{"code":"26725","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each ","code_information":[{"code":"26720","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia ","code_information":[{"code":"27266","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia ","code_information":[{"code":"27266","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia ","code_information":[{"code":"27265","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; without anesthesia ","code_information":[{"code":"27265","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27197","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27197","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27197","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27197","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; with manipulation ","code_information":[{"code":"27781","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction ","code_information":[{"code":"23605","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia ","code_information":[{"code":"27831","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia ","code_information":[{"code":"27830","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia ","code_information":[{"code":"27830","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; with manipulation ","code_information":[{"code":"25565","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation ","code_information":[{"code":"24640","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) ","code_information":[{"code":"25520","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) ","code_information":[{"code":"25520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture; without manipulation ","code_information":[{"code":"25500","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement) ","code_information":[{"code":"23575","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; without manipulation ","code_information":[{"code":"23570","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; without manipulation ","code_information":[{"code":"23570","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sesamoid fracture ","code_information":[{"code":"28530","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sesamoid fracture ","code_information":[{"code":"28530","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia ","code_information":[{"code":"23655","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation ","code_information":[{"code":"23675","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulation ","code_information":[{"code":"23675","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; without manipulation ","code_information":[{"code":"23520","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; without manipulation ","code_information":[{"code":"23520","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternum fracture ","code_information":[{"code":"21820","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27503","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation ","code_information":[{"code":"27501","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation ","code_information":[{"code":"27501","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation ","code_information":[{"code":"27501","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation ","code_information":[{"code":"27501","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"24535","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"24535","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"24535","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"24535","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talus fracture; with manipulation ","code_information":[{"code":"28435","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talus fracture; without manipulation ","code_information":[{"code":"28430","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talus fracture; without manipulation ","code_information":[{"code":"28430","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia ","code_information":[{"code":"28545","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia ","code_information":[{"code":"28540","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28605","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia ","code_information":[{"code":"28600","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia ","code_information":[{"code":"28600","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia ","code_information":[{"code":"28600","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of temporomandibular dislocation; initial or subsequent ","code_information":[{"code":"21480","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of temporomandibular dislocation; initial or subsequent ","code_information":[{"code":"21480","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction ","code_information":[{"code":"27532","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); without manipulation ","code_information":[{"code":"27530","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction ","code_information":[{"code":"27752","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation ","code_information":[{"code":"25680","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation ","code_information":[{"code":"25680","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; with manipulation ","code_information":[{"code":"27818","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; without manipulation ","code_information":[{"code":"27816","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; without manipulation ","code_information":[{"code":"27816","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); without manipulation ","code_information":[{"code":"24670","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar shaft fracture; without manipulation ","code_information":[{"code":"25530","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing ","code_information":[{"code":"22310","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction ","code_information":[{"code":"22315","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"CLOSED TX SPINE PROCESS FX ","code_information":[{"code":"22305","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Clostridium difficile toxin(s) antigen detection by immunoassay technique, stool, qualitative, multiple-step method ","code_information":[{"code":"0107U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.20,"maximum":24.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":24.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.00,"methodology":"fee schedule"}]}]},{"description":"Closure of anal fistula with rectal advancement flap ","code_information":[{"code":"46288","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of cystostomy (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"51880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of esophagostomy or fistula; cervical approach ","code_information":[{"code":"43420","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"40830","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"40830","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex ","code_information":[{"code":"40831","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex ","code_information":[{"code":"40831","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex ","code_information":[{"code":"40831","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of nephrocutaneous or pyelocutaneous fistula ","code_information":[{"code":"50520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication ","code_information":[{"code":"360","type":"RC"},{"code":"57308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by plug, each ","code_information":[{"code":"360","type":"RC"},{"code":"68761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of the lacrimal punctum; by plug, each ","code_information":[{"code":"499","type":"RC"},{"code":"68761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; ","code_information":[{"code":"369","type":"RC"},{"code":"57310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrovaginal fistula; ","code_information":[{"code":"481","type":"RC"},{"code":"57310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula, abdominal approach ","code_information":[{"code":"490","type":"RC"},{"code":"51900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula, abdominal approach ","code_information":[{"code":"51900","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; transvesical and vaginal approach ","code_information":[{"code":"361","type":"RC"},{"code":"57330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; vaginal approach ","code_information":[{"code":"490","type":"RC"},{"code":"57320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure postauricular fistula, mastoid (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"69700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closure salivary fistula ","code_information":[{"code":"360","type":"RC"},{"code":"42600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":" Clinic Family Practice  ","code_information":[{"code":"517","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":34.40,"standard_charge_algorithm":"Reimbursement will be 34.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_percentage":22.20,"standard_charge_algorithm":"Reimbursement will be 22.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Clinic Pediatric  ","code_information":[{"code":"515","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":34.40,"standard_charge_algorithm":"Reimbursement will be 34.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_percentage":22.20,"standard_charge_algorithm":"Reimbursement will be 22.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" CT Scan - Body Scan  ","code_information":[{"code":"352","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":325.00,"maximum":1723.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":510.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":425.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":1205.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1723.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":325.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":1070.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":1249.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":487.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Medical/Surgical Supplies and Devices Other Implant  ","code_information":[{"code":"278","type":"RC"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":84.70,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 84.7% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":94.70,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 94.7% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":73.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 73% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":50.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1000 reimbursement is 50% of aggregated billable gross charges. If aggregated billable gross charges are less than $1000 then reimbursement for the specified code will be zero.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":87.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 87% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":80.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 80% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":80.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 80% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":80.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 80% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":80.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 80% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":81.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 81% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":47.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 47% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":80.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 80% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":39.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1080 reimbursement is 39% of aggregated billable gross charges. If aggregated billable gross charges are less than $1080 then reimbursement for the specified code will be zero.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":85.70,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 85.7% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":88.50,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 88.5% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 50% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":50.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 50% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":99.00,"standard_charge_algorithm":"Reimbursement will be 99% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_percentage":58.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 58% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":55.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 55% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 50% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":38.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1000 reimbursement is 38% of aggregated billable gross charges. If aggregated billable gross charges are less than $1000 then reimbursement for the specified code will be zero.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 50% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":55.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 55% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":59.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 59% of billable gross charges in addition to other contracted rates.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Unlisted procedure, hemic or lymphatic system ","code_information":[{"code":"38999","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, hemic or lymphatic system ","code_information":[{"code":"38999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, humerus or elbow ","code_information":[{"code":"24999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, inner ear ","code_information":[{"code":"369","type":"RC"},{"code":"69949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, lacrimal system ","code_information":[{"code":"369","type":"RC"},{"code":"68899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, larynx ","code_information":[{"code":"31599","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, larynx ","code_information":[{"code":"31599","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, leg or ankle ","code_information":[{"code":"27899","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, lips ","code_information":[{"code":"360","type":"RC"},{"code":"40799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, liver ","code_information":[{"code":"47399","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, lungs and pleura ","code_information":[{"code":"32999","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, lungs and pleura ","code_information":[{"code":"32999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, male genital system ","code_information":[{"code":"55899","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, maternity care and delivery ","code_information":[{"code":"360","type":"RC"},{"code":"59899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, maternity care and delivery ","code_information":[{"code":"481","type":"RC"},{"code":"59899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, middle ear ","code_information":[{"code":"69799","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, musculoskeletal system, general ","code_information":[{"code":"20999","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, nose ","code_information":[{"code":"30999","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, orbit ","code_information":[{"code":"369","type":"RC"},{"code":"67599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, palate, uvula ","code_information":[{"code":"42299","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pancreas ","code_information":[{"code":"48999","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pharynx, adenoids, or tonsils ","code_information":[{"code":"42999","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, posterior segment ","code_information":[{"code":"499","type":"RC"},{"code":"67299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, rectum ","code_information":[{"code":"361","type":"RC"},{"code":"45999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, shoulder ","code_information":[{"code":"23929","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, skin, mucous membrane and subcutaneous tissue ","code_information":[{"code":"17999","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, skin, mucous membrane and subcutaneous tissue ","code_information":[{"code":"17999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, spine ","code_information":[{"code":"22899","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, spine ","code_information":[{"code":"22899","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3933.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, temporal bone, middle fossa approach ","code_information":[{"code":"360","type":"RC"},{"code":"69979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, temporal bone, middle fossa approach ","code_information":[{"code":"69979","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, trachea, bronchi ","code_information":[{"code":"31899","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, trachea, bronchi ","code_information":[{"code":"31899","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, trachea, bronchi ","code_information":[{"code":"31899","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, urinary system ","code_information":[{"code":"490","type":"RC"},{"code":"53899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular surgery ","code_information":[{"code":"360","type":"RC"},{"code":"37799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular surgery ","code_information":[{"code":"37799","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vestibule of mouth ","code_information":[{"code":"369","type":"RC"},{"code":"40899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted vascular endoscopy procedure ","code_information":[{"code":"37501","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"UPPER GI W/ESPH DILATION ","code_information":[{"code":"595269","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1401.00,"discounted_cash":1401.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":105.08,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":252.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":116.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":100.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":210.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1120.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":224.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":322.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":322.23,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":238.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1190.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1050.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":130.29,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1120.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1190.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":700.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":189.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2031.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":630.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":354.45,"methodology":"percent of total billed charges"}]}]},{"description":"Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code f ","code_information":[{"code":"481","type":"RC"},{"code":"50705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code f ","code_information":[{"code":"490","type":"RC"},{"code":"50705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"499","type":"RC"},{"code":"50955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without ","code_information":[{"code":"361","type":"RC"},{"code":"50957","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without ","code_information":[{"code":"481","type":"RC"},{"code":"50957","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"369","type":"RC"},{"code":"50961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"490","type":"RC"},{"code":"50961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without di ","code_information":[{"code":"50953","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"360","type":"RC"},{"code":"50970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"360","type":"RC"},{"code":"50974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"481","type":"RC"},{"code":"50974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"490","type":"RC"},{"code":"50974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy ","code_information":[{"code":"361","type":"RC"},{"code":"50976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ure ","code_information":[{"code":"360","type":"RC"},{"code":"50972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ure ","code_information":[{"code":"481","type":"RC"},{"code":"50972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Urethrectomy, total, including cystostomy; female ","code_information":[{"code":"53210","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrectomy, total, including cystostomy; male ","code_information":[{"code":"361","type":"RC"},{"code":"53215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring) ","code_information":[{"code":"361","type":"RC"},{"code":"53500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring) ","code_information":[{"code":"481","type":"RC"},{"code":"53500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethromeatoplasty, with mucosal advancement ","code_information":[{"code":"361","type":"RC"},{"code":"53450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethromeatoplasty, with mucosal advancement ","code_information":[{"code":"481","type":"RC"},{"code":"53450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia ","code_information":[{"code":"54316","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm ","code_information":[{"code":"360","type":"RC"},{"code":"54312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm ","code_information":[{"code":"481","type":"RC"},{"code":"54312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); greater than 3 cm ","code_information":[{"code":"490","type":"RC"},{"code":"54312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm ","code_information":[{"code":"490","type":"RC"},{"code":"54308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg, third stage Cecil repair) ","code_information":[{"code":"499","type":"RC"},{"code":"54318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, Tenago, Leadbetter procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"53431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, Tenago, Leadbetter procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"53431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (eg, Tenago, Leadbetter procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"53431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 1-stage reconstruction of male anterior urethra ","code_information":[{"code":"481","type":"RC"},{"code":"53410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 1-stage reconstruction of male anterior urethra ","code_information":[{"code":"490","type":"RC"},{"code":"53410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage ","code_information":[{"code":"360","type":"RC"},{"code":"53425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, reconstruction of female urethra ","code_information":[{"code":"499","type":"RC"},{"code":"53430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra ","code_information":[{"code":"53415","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type) ","code_information":[{"code":"369","type":"RC"},{"code":"53400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty; second stage (formation of urethra), including urinary diversion ","code_information":[{"code":"490","type":"RC"},{"code":"53405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury, female ","code_information":[{"code":"499","type":"RC"},{"code":"53502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; penile ","code_information":[{"code":"53505","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; perineal ","code_information":[{"code":"499","type":"RC"},{"code":"53510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous ","code_information":[{"code":"53515","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external ","code_information":[{"code":"369","type":"RC"},{"code":"53010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"US BRST BX 1ST LESION LT ","code_information":[{"code":"790735","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":61391.00,"discounted_cash":61391.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4604.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11050.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5095.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4420.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":9208.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":9822.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":10436.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46043.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":5709.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":8287.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":89016.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27625.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15531.92,"methodology":"percent of total billed charges"}]}]},{"description":"US BRST BX 1ST LESION LT ","code_information":[{"code":"791076","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":61391.00,"discounted_cash":61391.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4604.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11050.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5095.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4420.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":9208.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":9822.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":10436.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46043.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":5709.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":8287.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":89016.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27625.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15531.92,"methodology":"percent of total billed charges"}]}]},{"description":"US BRST BX ADD LESION RT ","code_information":[{"code":"790739","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":61391.00,"discounted_cash":61391.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4604.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11050.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5095.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4420.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":9208.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":9822.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":10436.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46043.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":5709.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":8287.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":89016.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27625.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15531.92,"methodology":"percent of total billed charges"}]}]},{"description":"US DVC PLC BRST ADD LT ","code_information":[{"code":"790744","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":13003.00,"discounted_cash":13003.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":975.23,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2340.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1079.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":936.22,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1950.45,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10402.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2080.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2990.69,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2990.69,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2210.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11052.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9752.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1209.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10402.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11052.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6501.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1755.40,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":18854.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5851.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3289.76,"methodology":"percent of total billed charges"}]}]},{"description":"Use of ophthalmic endoscope (List separately in addition to code for primary procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"66990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Uvulectomy, excision of uvula ","code_information":[{"code":"42140","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Uvulectomy, excision of uvula ","code_information":[{"code":"42140","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only (with or without episiotomy and/or forceps); ","code_information":[{"code":"369","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"59612","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C ","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":895.00,"maximum":2942.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2559.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":1653.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2204.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1450.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":2942.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":2701.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":1527.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1208.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":2720.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":2829.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":895.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":995.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1025.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":1053.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC ","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":995.00,"maximum":2942.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2559.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":1653.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2204.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1450.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":2942.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":2701.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":1527.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":2674.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1208.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":2720.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":2829.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":995.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1025.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":1053.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; ","code_information":[{"code":"58260","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control ","code_information":[{"code":"369","type":"RC"},{"code":"58267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) ","code_information":[{"code":"499","type":"RC"},{"code":"58262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele ","code_information":[{"code":"369","type":"RC"},{"code":"58263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele ","code_information":[{"code":"369","type":"RC"},{"code":"58270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; ","code_information":[{"code":"360","type":"RC"},{"code":"58290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; ","code_information":[{"code":"58290","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) ","code_information":[{"code":"360","type":"RC"},{"code":"58291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele ","code_information":[{"code":"361","type":"RC"},{"code":"58292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele ","code_information":[{"code":"481","type":"RC"},{"code":"58292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele ","code_information":[{"code":"369","type":"RC"},{"code":"58294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, with total or partial vaginectomy; ","code_information":[{"code":"361","type":"RC"},{"code":"58275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) ","code_information":[{"code":"360","type":"RC"},{"code":"57111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, partial removal of vaginal wall; ","code_information":[{"code":"57106","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) ","code_information":[{"code":"360","type":"RC"},{"code":"57107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) ","code_information":[{"code":"481","type":"RC"},{"code":"57109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) ","code_information":[{"code":"490","type":"RC"},{"code":"57109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginoplasty for intersex state ","code_information":[{"code":"57335","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); LAPAROSCOPIC REMOVAL OF VAGAL TRUNK NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR ","code_information":[{"code":"0314T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); LAPAROSCOPIC REVISION OR REPLACEMENT OF VAGAL TRUNK NEUROSTIMULATOR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR ","code_information":[{"code":"0313T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); NEUROSTIMULATOR PULSE GENERATOR ELECTRONIC ANALYSIS, INCLUDES REPROGRAMMING WHEN PERFORMED ","code_information":[{"code":"0317T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); REMOVAL OF PULSE GENERATOR ","code_information":[{"code":"0315T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); REPLACEMENT OF PULSE GENERATOR ","code_information":[{"code":"0316T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":13833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"}]}]},{"description":"Valproic acid (dipropylacetic acid); free ","code_information":[{"code":"80165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.86,"maximum":20.31,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"}]}]},{"description":"VALVE MODULE 125-20MMWIT ","code_information":[{"code":"860261","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, ot ","code_information":[{"code":"361","type":"RC"},{"code":"37242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, ot ","code_information":[{"code":"37242","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":20461.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, ot ","code_information":[{"code":"37242","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial ","code_information":[{"code":"37244","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, othe ","code_information":[{"code":"37241","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Vasopressin (antidiuretic hormone, ADH) ","code_information":[{"code":"156730","type":"CDM"},{"code":"84588","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32.24,"maximum":50.91,"gross_charge":296.00,"discounted_cash":296.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":40.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":42.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":38.01,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":33.60,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":33.60,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":33.79,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":32.24,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.94,"methodology":"fee schedule"}]}]},{"description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"55200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vasovasostomy, vasovasorrhaphy ","code_information":[{"code":"55400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Venipuncture, cutdown; younger than age 1 year ","code_information":[{"code":"36420","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Venipuncture, cutdown; younger than age 1 year ","code_information":[{"code":"36420","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Venous catheterization for selective organ blood sampling ","code_information":[{"code":"36500","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Venous catheterization for selective organ blood sampling ","code_information":[{"code":"36500","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Venous valve transposition, any vein donor ","code_information":[{"code":"34510","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Ventilating tube removal requiring general anesthesia ","code_information":[{"code":"69424","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection ","code_information":[{"code":"499","type":"RC"},{"code":"61020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH CC ","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":66991.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18390.89,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19018.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20987.69,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":18480.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":66991.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":61510.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":37684.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18121.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18121.75,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17489.74,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19736.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48961.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58558.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":18301.18,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18301.18,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":19557.14,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19018.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20095.41,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":18660.02,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17404.06,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18660.02,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":18301.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":19377.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22427.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14647.39,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18660.02,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17045.21,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18660.02,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":19377.72,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19736.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18480.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":46256.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17099.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":38167.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17942.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17404.06,"methodology":"fee schedule"}]}]},{"description":"VERSAPOINT BALL TIP ","code_information":[{"code":"826691","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2196.00,"discounted_cash":2196.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":362.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":164.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":419.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":316.22,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":395.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":549.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":483.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":285.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":182.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":158.11,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":329.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":485.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":437.00,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1756.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":351.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":505.08,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":461.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":746.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":505.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":373.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1866.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1647.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":204.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":285.48,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1756.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1866.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1098.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":296.46,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3184.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":625.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":988.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":555.59,"methodology":"percent of total billed charges"}]}]},{"description":"VERTEBRO LUMBOSACRAL ","code_information":[{"code":"791330","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":18351.00,"discounted_cash":18351.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1376.33,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3303.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1523.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1321.27,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":2752.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14680.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2936.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":4220.73,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4220.73,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":3119.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15598.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13763.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1706.64,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14680.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15598.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9175.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":2477.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":26608.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8257.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":4642.80,"methodology":"percent of total billed charges"}]}]},{"description":"Very long chain acyl-coenzyme A (CoA) dehydrogenase (VLCAD), leukocyte enzyme activity, whole blood ","code_information":[{"code":"0257U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":676.85,"maximum":1068.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":733.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":762.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":755.22,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1068.70,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":854.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":726.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":726.72,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":890.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":783.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":762.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":762.34,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":797.97,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":705.35,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":705.35,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":854.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":847.84,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":748.09,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":676.85,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":748.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":783.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":748.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":716.03,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":712.47,"methodology":"fee schedule"}]}]},{"description":"Vesiculectomy, any approach ","code_information":[{"code":"369","type":"RC"},{"code":"55650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Vesiculotomy; ","code_information":[{"code":"55600","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vesiculotomy; complicated ","code_information":[{"code":"499","type":"RC"},{"code":"55605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Vestibular nerve section, translabyrinthine approach ","code_information":[{"code":"69915","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; anterior ","code_information":[{"code":"360","type":"RC"},{"code":"40840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; anterior ","code_information":[{"code":"40840","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning) ","code_information":[{"code":"40845","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning) ","code_information":[{"code":"40845","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; entire arch ","code_information":[{"code":"40844","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; posterior, bilateral ","code_information":[{"code":"40843","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; posterior, bilateral ","code_information":[{"code":"40843","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; posterior, unilateral ","code_information":[{"code":"40842","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect ","code_information":[{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.77,"maximum":39.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":31.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":24.77,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"Vitamin A ","code_information":[{"code":"798597","type":"CDM"},{"code":"84590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.03,"maximum":17.41,"gross_charge":1.00,"discounted_cash":1.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":17.41,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":13.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed ","code_information":[{"code":"156436","type":"CDM"},{"code":"82652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36.57,"maximum":57.75,"gross_charge":183.00,"discounted_cash":183.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":41.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":57.75,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":46.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":48.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":41.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41.20,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":38.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38.50,"methodology":"fee schedule"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; ","code_information":[{"code":"369","type":"RC"},{"code":"67036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponad ","code_information":[{"code":"481","type":"RC"},{"code":"67042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponad ","code_information":[{"code":"490","type":"RC"},{"code":"67042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and la ","code_information":[{"code":"499","type":"RC"},{"code":"67043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) ","code_information":[{"code":"51797","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Voltage-gated calcium channel antibody, each ","code_information":[{"code":"156540","type":"CDM"},{"code":"86596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.45,"maximum":18.08,"gross_charge":177.00,"discounted_cash":177.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":13.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"Vulvectomy simple; complete ","code_information":[{"code":"499","type":"RC"},{"code":"56625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy simple; partial ","code_information":[{"code":"361","type":"RC"},{"code":"56620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, complete; ","code_information":[{"code":"499","type":"RC"},{"code":"56633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11895.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy ","code_information":[{"code":"361","type":"RC"},{"code":"56637","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy ","code_information":[{"code":"490","type":"RC"},{"code":"56632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"WAX BN 2.5GM ","code_information":[{"code":"814084","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":114.00,"discounted_cash":114.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":16.42,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":28.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":25.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":9.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":8.21,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":17.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":25.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":22.69,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":91.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":18.24,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":26.22,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":38.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.22,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":19.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":96.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":85.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":91.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":96.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":15.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":165.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":32.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":51.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":28.84,"methodology":"percent of total billed charges"}]}]},{"description":"Prostatotomy, external drainage of prostatic abscess, any approach; simple ","code_information":[{"code":"55720","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"PROTECTOR CAST LEG FULL ","code_information":[{"code":"826987","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":617.00,"discounted_cash":617.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":101.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":46.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":117.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":88.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":111.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":154.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":135.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":80.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":51.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":44.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":92.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":136.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":122.78,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":493.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":98.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":141.91,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":129.57,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":209.78,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":141.91,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":104.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":524.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":462.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":57.38,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":80.21,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":493.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":524.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":894.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":175.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":277.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":156.10,"methodology":"percent of total billed charges"}]}]},{"description":"Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each ","code_information":[{"code":"88372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.91,"maximum":39.33,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":26.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.74,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":29.37,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":31.20,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":28.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.22,"methodology":"fee schedule"}]}]},{"description":"Protein; electrophoretic fractionation and quantitation, serum ","code_information":[{"code":"117817","type":"CDM"},{"code":"84165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.20,"maximum":16.11,"gross_charge":53.00,"discounted_cash":53.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"Prothrombin time; ","code_information":[{"code":"117925","type":"CDM"},{"code":"85610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.08,"maximum":6.44,"gross_charge":325.00,"discounted_cash":325.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":109.50,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"Protoporphyrin, RBC; quantitative ","code_information":[{"code":"84202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.63,"maximum":21.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":21.52,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.35,"methodology":"fee schedule"}]}]},{"description":"Pterygomaxillary fossa surgery, any approach ","code_information":[{"code":"31040","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE ","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":27105.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12603.85,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":13034.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13848.63,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":12665.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":12419.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12419.40,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11540.53,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13526.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":19062.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27105.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12542.37,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12542.37,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":13403.12,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13034.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":13772.01,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":12788.30,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":11927.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12788.30,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":12542.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":13280.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15370.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9665.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":12788.30,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":11681.62,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":12788.30,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":13280.16,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":13526.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12665.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":11718.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12296.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11927.55,"methodology":"fee schedule"}]}]},{"description":"PUNCH BIOPSY DISP 5MM ","code_information":[{"code":"910787","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1161.00,"discounted_cash":1161.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":191.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":87.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":221.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":167.18,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":208.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":290.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":255.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":150.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":96.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":83.59,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":174.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":256.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":231.04,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":928.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":185.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":267.03,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":394.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":267.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":197.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":986.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":870.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":107.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":150.93,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":928.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":986.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":156.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1683.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":330.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":522.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":293.73,"methodology":"percent of total billed charges"}]}]},{"description":"PUNCH BX DISP 3MM ","code_information":[{"code":"940641","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":31.00,"discounted_cash":31.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":4.46,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":6.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2.23,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":4.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":6.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.17,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":4.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7.13,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":10.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":5.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":23.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.03,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":4.18,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":44.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":7.84,"methodology":"percent of total billed charges"}]}]},{"description":"PUNCH CRKSCR DISP FT 5.5 ","code_information":[{"code":"832423","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Punch graft for hair transplant; 1 to 15 punch grafts ","code_information":[{"code":"15775","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Punch graft for hair transplant; more than 15 punch grafts ","code_information":[{"code":"15776","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"PUNCH SURG 5MM ","code_information":[{"code":"833773","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":97.00,"discounted_cash":97.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":13.97,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":17.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":21.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":8.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":6.98,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":14.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":21.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":19.30,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":77.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":15.52,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":22.31,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22.31,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":16.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":82.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":72.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":77.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":82.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":13.10,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":140.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":27.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":43.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":24.54,"methodology":"percent of total billed charges"}]}]},{"description":"Puncture aspiration of abscess, hematoma, bulla, or cyst ","code_information":[{"code":"10160","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure) ","code_information":[{"code":"19001","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of medication ","code_information":[{"code":"55000","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Puncture of shunt tubing or reservoir for aspiration or injection procedure ","code_information":[{"code":"361","type":"RC"},{"code":"61070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Puncture of shunt tubing or reservoir for aspiration or injection procedure ","code_information":[{"code":"499","type":"RC"},{"code":"61070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Push transfusion, blood, 2 years or younger ","code_information":[{"code":"361","type":"RC"},{"code":"36440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Push transfusion, blood, 2 years or younger ","code_information":[{"code":"36440","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"PVB THORACIC SECONDARY ","code_information":[{"code":"797148","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3324.00,"discounted_cash":3324.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":249.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":598.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":275.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":239.33,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":498.60,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2659.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":531.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":764.52,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":764.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":565.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2825.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2493.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":309.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2659.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2825.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":448.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4819.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1495.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":840.97,"methodology":"percent of total billed charges"}]}]},{"description":"PVB THORACIC SINGLE ","code_information":[{"code":"797149","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3324.00,"discounted_cash":3324.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":249.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":598.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":275.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":239.33,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":498.60,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2659.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":531.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":764.52,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":764.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":565.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2825.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2493.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":309.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2659.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2825.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1662.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":448.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4819.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1495.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":840.97,"methodology":"percent of total billed charges"}]}]},{"description":"Quadricepsplasty (eg, Bennett or Thompson type) ","code_information":[{"code":"27430","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Radial keratotomy ","code_information":[{"code":"65771","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radial styloidectomy (separate procedure) ","code_information":[{"code":"25230","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based ","code_information":[{"code":"77371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10400.00,"maximum":30898.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":21481.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19831.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":17918.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13440.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":30898.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":28078.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":28078.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":28078.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":28078.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":28371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":14708.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":28078.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11200.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":21093.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26636.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":18000.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":15206.00,"methodology":"case rate"}]}]},{"description":"Radical excision external auditory canal lesion; without neck dissection ","code_information":[{"code":"499","type":"RC"},{"code":"69150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors ","code_information":[{"code":"25115","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure) ","code_information":[{"code":"24149","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure) ","code_information":[{"code":"24149","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with local flap (eg, tongue, buccal) ","code_information":[{"code":"360","type":"RC"},{"code":"42844","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without closure ","code_information":[{"code":"361","type":"RC"},{"code":"42842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; 5 cm or greater ","code_information":[{"code":"22905","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cm ","code_information":[{"code":"22904","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater ","code_information":[{"code":"21936","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cm ","code_information":[{"code":"21935","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greater ","code_information":[{"code":"21016","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm ","code_information":[{"code":"21015","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3 cm or greater ","code_information":[{"code":"28047","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm ","code_information":[{"code":"28046","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; 3 cm or greater ","code_information":[{"code":"26118","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; less than 3 cm ","code_information":[{"code":"26117","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; 5 cm or greater ","code_information":[{"code":"27616","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cm ","code_information":[{"code":"27615","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cm ","code_information":[{"code":"27615","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater ","code_information":[{"code":"21558","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm ","code_information":[{"code":"21557","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; less than 5 cm ","code_information":[{"code":"27049","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greater ","code_information":[{"code":"23078","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greater ","code_information":[{"code":"23078","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; less than 5 cm ","code_information":[{"code":"23077","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; 5 cm or greater ","code_information":[{"code":"27364","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cm ","code_information":[{"code":"27329","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; less than 5 cm ","code_information":[{"code":"24077","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, distal phalanx of finger ","code_information":[{"code":"26262","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, metacarpal ","code_information":[{"code":"26250","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, proximal or middle phalanx of finger ","code_information":[{"code":"26260","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, radial head or neck ","code_information":[{"code":"24152","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, shaft or distal humerus ","code_information":[{"code":"24150","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor; metatarsal ","code_information":[{"code":"28173","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor; phalanx of toe ","code_information":[{"code":"28175","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor; talus or calcaneus ","code_information":[{"code":"27647","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor; talus or calcaneus ","code_information":[{"code":"27647","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor; tarsal (except talus or calcaneus) ","code_information":[{"code":"28171","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Rare diseases, whole genome sequence analysis, incl small sequence changes, copy number variants, deletions, duplications, mobile element insertions, UPD, inversions, aneuploidy, mitochondrial genome ","code_information":[{"code":"0336U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2445.92,"maximum":3861.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2651.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2754.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2729.13,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3861.98,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":3089.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":2626.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2626.14,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":3218.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2832.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2754.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2754.88,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2883.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2548.90,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2548.90,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3089.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3063.83,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":2703.38,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":2445.92,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":2703.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2832.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":2703.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":2587.52,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"}]}]},{"description":"RBC DEGLYCEROLIZED EA UN ","code_information":[{"code":"122222","type":"CDM"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":861.00,"discounted_cash":861.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":142.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":164.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":123.98,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":154.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":215.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":189.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":111.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":129.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":190.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":171.34,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":688.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":198.03,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":180.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":292.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":198.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":146.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":731.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":645.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":80.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":111.93,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":688.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":731.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":430.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":116.23,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1248.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":245.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":387.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":217.83,"methodology":"percent of total billed charges"}]}]},{"description":"Real-time spectral analysis of prostate tissue by fluorescence spectroscopy, including imaging guidance (List separately in addition to code for primary procedure) ","code_information":[{"code":"0443T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"REAMER CANN LNG 4.0MM ","code_information":[{"code":"921768","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2365.00,"discounted_cash":2365.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":390.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":177.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":451.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":340.56,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":425.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":591.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":520.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":307.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":196.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":170.28,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":354.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":522.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":470.63,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1892.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":378.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":543.95,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":804.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":543.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":402.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2010.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1773.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":219.94,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":307.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1892.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2010.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":319.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3429.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":674.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1064.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":598.35,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER CANN MTP CUP 18MM ","code_information":[{"code":"926889","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4098.00,"discounted_cash":4098.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":676.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":307.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":782.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":590.11,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":737.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1024.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":901.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":532.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":340.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":295.06,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":614.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":905.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":815.50,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3278.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":655.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":942.54,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":860.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1393.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":942.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":696.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3483.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3073.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":381.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":532.74,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3278.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3483.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2049.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":553.23,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5942.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1167.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1844.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1036.79,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER CORING CANN 8MM ","code_information":[{"code":"931970","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER HEAD STRL 11.0MM ","code_information":[{"code":"919868","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 10.0MM ","code_information":[{"code":"839507","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 11MM LPRO ","code_information":[{"code":"802483","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2891.00,"discounted_cash":2891.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":477.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":216.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":552.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":416.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":520.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":722.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":636.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":375.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":239.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":208.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":433.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":638.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":575.31,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2312.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":462.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":664.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":982.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":664.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":491.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2457.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2168.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":268.86,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":375.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2312.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2457.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":390.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4191.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":823.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1300.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":731.42,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 20MM GLND ","code_information":[{"code":"929829","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3774.00,"discounted_cash":3774.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":622.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":283.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":720.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":543.46,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":679.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":943.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":830.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":490.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":313.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":271.73,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":566.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":834.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":751.03,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3019.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":603.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":868.02,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":792.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1283.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":868.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":641.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3207.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2830.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":350.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":490.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3019.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3207.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":509.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5472.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1075.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1698.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":954.82,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 22MM ","code_information":[{"code":"806214","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4731.00,"discounted_cash":4731.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":780.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":354.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":903.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":681.26,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":851.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1182.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1040.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":615.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":392.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":340.63,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":709.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1045.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":941.47,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3784.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":756.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1088.13,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":993.51,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1608.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1088.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":804.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4021.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3548.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":439.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":615.03,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3784.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4021.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2365.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":638.68,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6859.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1348.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2128.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1196.94,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 4.5X9.0MM ","code_information":[{"code":"925890","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3956.00,"discounted_cash":3956.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":652.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":296.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":755.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":569.66,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":712.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":989.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":870.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":514.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":328.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":284.83,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":593.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":874.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":787.24,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3164.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":632.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":909.88,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":830.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1345.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":909.88,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":672.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3362.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2967.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":367.91,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":514.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3164.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3362.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1978.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":534.06,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5736.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1127.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1780.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1000.87,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 7.0MM ","code_information":[{"code":"870050","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 7MM ","code_information":[{"code":"837991","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG 8.5MM ","code_information":[{"code":"856890","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2934.00,"discounted_cash":2934.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":484.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":220.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":560.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":422.50,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":528.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":733.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":645.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":381.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":243.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":211.25,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":440.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":648.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":583.87,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2347.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":469.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":674.82,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":616.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":997.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":674.82,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":498.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2493.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2200.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":272.86,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":381.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2347.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2493.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1467.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":396.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4254.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":836.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1320.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":742.30,"methodology":"percent of total billed charges"}]}]},{"description":"REAMER SURG CUP 20MM ","code_information":[{"code":"944199","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":8533.00,"discounted_cash":8533.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":1407.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":639.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1629.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":1228.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1535.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2133.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1877.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1109.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":708.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":614.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1279.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1885.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1698.07,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6826.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1365.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1962.59,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1791.93,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2901.22,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1962.59,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1450.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7253.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6399.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":793.57,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1109.29,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6826.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7253.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4266.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1151.95,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":12372.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2431.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3839.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2158.85,"methodology":"percent of total billed charges"}]}]},{"description":"REAMR SURG 18MM CANN KIT ","code_information":[{"code":"869128","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure) ","code_information":[{"code":"28238","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial ","code_information":[{"code":"21181","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial ","code_information":[{"code":"21181","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction external auditory canal for congenital atresia, single stage ","code_information":[{"code":"69320","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without o ","code_information":[{"code":"25337","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft) ","code_information":[{"code":"24346","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft) ","code_information":[{"code":"24346","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome) ","code_information":[{"code":"21150","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) ","code_information":[{"code":"23420","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) ","code_information":[{"code":"23420","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of dislocating patella; (eg, Hauser type procedure) ","code_information":[{"code":"27420","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure) ","code_information":[{"code":"27422","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of dislocating patella; with patellectomy ","code_information":[{"code":"27424","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"69310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage ","code_information":[{"code":"369","type":"RC"},{"code":"67975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage ","code_information":[{"code":"361","type":"RC"},{"code":"67973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage ","code_information":[{"code":"481","type":"RC"},{"code":"67973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage ","code_information":[{"code":"490","type":"RC"},{"code":"67973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage ","code_information":[{"code":"361","type":"RC"},{"code":"67974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage ","code_information":[{"code":"499","type":"RC"},{"code":"67974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete ","code_information":[{"code":"21249","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial ","code_information":[{"code":"21248","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandible or maxilla, subperiosteal implant; complete ","code_information":[{"code":"21246","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandible or maxilla, subperiosteal implant; partial ","code_information":[{"code":"21245","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate) ","code_information":[{"code":"21244","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation ","code_information":[{"code":"21196","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft ","code_information":[{"code":"21193","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia) ","code_information":[{"code":"21256","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of polydactylous digit, soft tissue and bone ","code_information":[{"code":"26587","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure) ","code_information":[{"code":"26500","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure) ","code_information":[{"code":"26500","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure) ","code_information":[{"code":"26502","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure) ","code_information":[{"code":"26502","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts) ","code_information":[{"code":"21172","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts) ","code_information":[{"code":"21172","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining au ","code_information":[{"code":"21175","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, cleft foot ","code_information":[{"code":"28360","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint ","code_information":[{"code":"26545","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement) ","code_information":[{"code":"26542","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft) ","code_information":[{"code":"26541","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe(s); polydactyly ","code_information":[{"code":"28344","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe(s); polydactyly ","code_information":[{"code":"28344","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe(s); polydactyly ","code_information":[{"code":"28344","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web ","code_information":[{"code":"28345","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe, macrodactyly; requiring bone resection ","code_information":[{"code":"28341","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstruction, toe, macrodactyly; soft tissue resection ","code_information":[{"code":"28340","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy ","code_information":[{"code":"21743","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy ","code_information":[{"code":"21742","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"RECOVERY PAIN 1ST HOUR ","code_information":[{"code":"157429","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1812.00,"discounted_cash":1812.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":298.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":135.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":260.93,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":326.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":398.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":150.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":130.46,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":271.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":400.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":360.59,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1449.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":289.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":416.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":380.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":616.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":416.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":308.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1540.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1359.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":168.52,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1449.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1540.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":906.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":244.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2627.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":516.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":815.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":458.44,"methodology":"percent of total billed charges"}]}]},{"description":"RECTAL RESECTION WITH MCC ","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":66720.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29010.54,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":30001.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":34088.42,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":29152.06,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":28586.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28586.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":28407.01,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31133.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46921.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":66720.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":28869.03,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28869.03,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":30850.24,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30001.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":31699.33,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":29435.09,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":27453.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29435.09,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":28869.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":30567.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35378.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23790.44,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":29435.09,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":26887.82,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":29435.09,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":30567.21,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":31133.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29152.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":26972.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":28302.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27453.88,"methodology":"fee schedule"}]}]},{"description":"Rectal sensation, tone, and compliance test (ie, response to graded balloon distention) ","code_information":[{"code":"499","type":"RC"},{"code":"91120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Red cell antigen (Duffy blood group) genotyping (FY), gene analysis, ACKR1 (atypical chemokine receptor 1) exons 1-2 ","code_information":[{"code":"0187U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261.09,"maximum":412.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":283.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":412.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":343.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":307.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":327.05,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"}]}]},{"description":"Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) ","code_information":[{"code":"21138","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) ","code_information":[{"code":"21138","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) ","code_information":[{"code":"21138","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring only ","code_information":[{"code":"21137","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring only ","code_information":[{"code":"21137","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring only ","code_information":[{"code":"21137","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction forehead; contouring only ","code_information":[{"code":"21137","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approach ","code_information":[{"code":"21295","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Reduction of overcorrection of ptosis ","code_information":[{"code":"369","type":"RC"},{"code":"67909","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction of torsion of testis, surgical, with or without fixation of contralateral testis ","code_information":[{"code":"361","type":"RC"},{"code":"54600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction of torsion of testis, surgical, with or without fixation of contralateral testis ","code_information":[{"code":"481","type":"RC"},{"code":"54600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Reduction of torsion of testis, surgical, with or without fixation of contralateral testis ","code_information":[{"code":"490","type":"RC"},{"code":"54600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"REFILL KIT PROMETRA ","code_information":[{"code":"871117","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":557.00,"discounted_cash":557.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":91.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":41.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":106.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":80.21,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":100.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":139.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":122.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":72.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":46.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":40.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":83.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":123.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":110.84,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":445.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":89.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":128.11,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":189.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":128.11,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":94.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":473.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":417.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":51.80,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":72.41,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":445.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":473.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":75.19,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":807.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":158.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":250.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":140.92,"methodology":"percent of total billed charges"}]}]},{"description":"REFILL/MAINT PUMP DRG DL ","code_information":[{"code":"596037","type":"CDM"},{"code":"96522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1178.00,"discounted_cash":1178.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":212.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":589.00,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":589.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":589.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":942.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":270.94,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1001.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":883.50,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":153.14,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":589.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":942.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1001.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":589.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":335.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":530.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":298.03,"methodology":"percent of total billed charges"}]}]},{"description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; ","code_information":[{"code":"369","type":"RC"},{"code":"95990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requirin ","code_information":[{"code":"499","type":"RC"},{"code":"95991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Reinsertion of ocular implant; with or without conjunctival graft ","code_information":[{"code":"499","type":"RC"},{"code":"65150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft ","code_information":[{"code":"24342","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Release of encircling material (posterior segment) ","code_information":[{"code":"499","type":"RC"},{"code":"67115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Release of extensive scar tissue without detaching extraocular muscle (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"67343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Release of extensive scar tissue without detaching extraocular muscle (separate procedure) ","code_information":[{"code":"67343","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Release of thenar muscle(s) (eg, thumb contracture) ","code_information":[{"code":"26508","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Release, intrinsic muscles of hand, each muscle ","code_information":[{"code":"26593","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Release, tarsal tunnel (posterior tibial nerve decompression) ","code_information":[{"code":"28035","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"RELOAD STPLR 45MM ","code_information":[{"code":"853217","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1090.00,"discounted_cash":1090.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":179.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":81.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":208.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":156.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":196.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":272.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":239.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":141.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":90.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":78.48,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":163.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":240.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":216.91,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":872.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":174.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":250.70,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":228.90,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":370.60,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":250.70,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":185.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":926.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":817.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":101.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":141.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":872.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":926.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":545.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":147.15,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1580.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":310.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":490.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":275.77,"methodology":"percent of total billed charges"}]}]},{"description":"Relocation of skin pocket for implanted cardiac contractility modulation pulse generator ","code_information":[{"code":"0416T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"REM CALC/DEB PERC BIL ","code_information":[{"code":"791972","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":28291.00,"discounted_cash":28291.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2121.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5092.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2348.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2036.95,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":4243.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":22632.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":4526.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":6506.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6506.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":4809.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":24047.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":21218.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2631.06,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":22632.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":24047.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14145.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":3819.28,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":41021.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12730.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":7157.62,"methodology":"percent of total billed charges"}]}]},{"description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation ","code_information":[{"code":"361","type":"RC"},{"code":"50382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation ","code_information":[{"code":"481","type":"RC"},{"code":"50382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation ","code_information":[{"code":"490","type":"RC"},{"code":"50382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation ","code_information":[{"code":"50384","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session ","code_information":[{"code":"361","type":"RC"},{"code":"54410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session ","code_information":[{"code":"481","type":"RC"},{"code":"54410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session ","code_information":[{"code":"490","type":"RC"},{"code":"54410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected ti ","code_information":[{"code":"369","type":"RC"},{"code":"54411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation ","code_information":[{"code":"499","type":"RC"},{"code":"50387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation ","code_information":[{"code":"50387","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session ","code_information":[{"code":"53447","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":11482.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff through an infected field at the same operative session including irrigation and debridement o ","code_information":[{"code":"361","type":"RC"},{"code":"53448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"REMOVAL AND REPLACEMENT OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA, PULSE GENERATOR ONLY ","code_information":[{"code":"0431T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":12947.00,"maximum":13833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12947.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"}]}]},{"description":"REMOVAL AND REPLACEMENT OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA, PULSE GENERATOR ONLY ","code_information":[{"code":"0431T","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":12947.00,"maximum":13833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12947.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session ","code_information":[{"code":"499","type":"RC"},{"code":"54416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of ","code_information":[{"code":"369","type":"RC"},{"code":"54417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of ","code_information":[{"code":"490","type":"RC"},{"code":"54417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":32646.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":23431.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of permanent cardiac contractility modulation system pulse generator only ","code_information":[{"code":"0414T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":76506.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":76506.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":53616.00,"methodology":"case rate"}]}]},{"description":"Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia) ","code_information":[{"code":"21029","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; with general anesthesia ","code_information":[{"code":"490","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; by lateral rhinotomy ","code_information":[{"code":"30320","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; office type procedure ","code_information":[{"code":"30300","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; requiring general anesthesia ","code_information":[{"code":"30310","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal impacted cerumen using irrigation/lavage, unilateral ","code_information":[{"code":"69209","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis ","code_information":[{"code":"54406","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of anal seton, other marker ","code_information":[{"code":"46030","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of ankle implant ","code_information":[{"code":"27704","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidan ","code_information":[{"code":"369","type":"RC"},{"code":"47537","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of blood clot, anterior segment of eye ","code_information":[{"code":"490","type":"RC"},{"code":"65930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging ","code_information":[{"code":"47544","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of complete cerebrospinal fluid shunt system; without replacement ","code_information":[{"code":"361","type":"RC"},{"code":"62256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of corneal epithelium; with application of chelating agent (eg, EDTA) ","code_information":[{"code":"65436","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ","code_information":[{"code":"490","type":"RC"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator ","code_information":[{"code":"361","type":"RC"},{"code":"64570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator ","code_information":[{"code":"499","type":"RC"},{"code":"64570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body from dentoalveolar structures; bone ","code_information":[{"code":"41806","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body from dentoalveolar structures; soft tissues ","code_information":[{"code":"41805","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, eyelid ","code_information":[{"code":"360","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, vestibule of mouth; complicated ","code_information":[{"code":"361","type":"RC"},{"code":"40805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of entire lumbosubarachnoid shunt system without replacement ","code_information":[{"code":"360","type":"RC"},{"code":"63746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of entire lumbosubarachnoid shunt system without replacement ","code_information":[{"code":"63746","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in muscle or tendon sheath; deep or complicated ","code_information":[{"code":"20525","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, mandible, segmental; ","code_information":[{"code":"21198","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, mandible, segmental; with genioglossus advancement ","code_information":[{"code":"21199","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, mandible, segmental; with genioglossus advancement ","code_information":[{"code":"21199","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, mandible, segmental; with genioglossus advancement ","code_information":[{"code":"21199","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, radius; middle or proximal third ","code_information":[{"code":"25355","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, radius; middle or proximal third ","code_information":[{"code":"25355","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure) ","code_information":[{"code":"28310","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure) ","code_information":[{"code":"28310","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, Fowler type) ","code_information":[{"code":"28305","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe) ","code_information":[{"code":"28307","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe) ","code_information":[{"code":"28307","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each ","code_information":[{"code":"28308","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation ","code_information":[{"code":"28300","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; phalanx of finger, each ","code_information":[{"code":"26567","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; phalanx of finger, each ","code_information":[{"code":"26567","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; talus ","code_information":[{"code":"28302","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; tibia and fibula ","code_information":[{"code":"27709","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; ulna ","code_information":[{"code":"25360","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Osteotomy; ulna ","code_information":[{"code":"25360","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":16184.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7882.77,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":8151.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8024.56,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":7921.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":7767.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7767.41,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6687.14,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8459.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11045.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15706.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":7844.31,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7844.31,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8382.65,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8151.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":8613.36,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":7998.12,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7459.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7998.12,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":7844.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8305.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9613.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5600.37,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":7998.12,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":7305.98,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":7998.12,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8305.74,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":8459.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7921.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7329.05,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":7690.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7459.79,"methodology":"fee schedule"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC ","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":114764.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":80652.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26123.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":97084.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":69472.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":27015.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":30526.75,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":26250.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":114764.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":104287.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":104287.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":104287.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":104287.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":105377.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":64560.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":104287.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":25741.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25741.10,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":25438.96,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28034.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":67319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":80481.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":25995.96,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25995.96,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":27780.00,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27015.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":25000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":28544.59,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":26505.69,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":24721.65,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26505.69,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":30100.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":25995.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":27525.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31857.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21304.74,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":26505.69,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":24211.93,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":26505.69,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":27525.14,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":28034.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26250.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":77319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":24288.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":63798.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":25486.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24721.65,"methodology":"fee schedule"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC ","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":18510.80,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9044.32,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":9353.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9457.48,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":9088.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8911.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8911.96,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7881.24,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9706.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":13017.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18510.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":9000.20,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9000.20,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":9617.86,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9353.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9882.57,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":9176.67,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8559.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9176.67,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":9000.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9529.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11029.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6600.42,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":9176.67,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":8382.54,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":9176.67,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":9529.62,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9706.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9088.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8409.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8823.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8559.01,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":12934.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6734.76,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":6964.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6608.35,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":6767.61,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":6636.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6636.20,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5506.96,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7227.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":9096.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12934.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":6701.91,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6701.91,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":7161.84,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6964.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":7358.96,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":6833.32,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6373.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6833.32,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":6701.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7096.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8213.12,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4611.99,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6833.32,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":6241.97,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6833.32,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":7096.14,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":7227.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6767.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6261.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":6570.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6373.38,"methodology":"fee schedule"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC ","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":59589.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":45186.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19817.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":51227.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":38458.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":20494.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":22747.89,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":19914.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":59589.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":54715.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":33522.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":19527.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19527.71,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":18956.57,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21267.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":20401.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24469.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":19721.06,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19721.06,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":21074.46,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20494.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":23201.24,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":20107.74,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":18754.34,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20107.74,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":19721.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":20881.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24167.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15875.84,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":20107.74,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":18367.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":20107.74,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":20881.12,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":21267.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19914.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":53353.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":18425.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":44020.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":19334.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18754.34,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":13840.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7109.99,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":7352.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7071.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":7144.68,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":7005.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7005.94,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5892.70,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7630.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":9733.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13840.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":7075.31,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7075.31,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":7560.87,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7352.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":7768.97,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":7214.04,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6728.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7214.04,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":7075.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7491.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8670.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4935.05,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":7214.04,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":6589.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":7214.04,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":7491.50,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":7630.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7144.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6610.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":6936.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6728.48,"methodology":"fee schedule"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC ","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":50530.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17403.81,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":17998.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":19770.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":17488.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":40668.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":36955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":36955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":36955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":36955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37340.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":22877.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":36955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":17149.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17149.12,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16475.00,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18677.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":27212.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38695.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":17318.92,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17318.92,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":18507.47,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17998.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":19016.85,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":17658.50,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":16469.95,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17658.50,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":17318.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":18337.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21224.16,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13797.56,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":17658.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":16130.36,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":17658.50,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":18337.68,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":18677.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17488.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":50530.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":16181.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":41691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":16979.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16469.95,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES ","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":36415.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16459.75,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":17021.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":18605.39,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":16540.04,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":16218.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16218.87,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15504.49,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17664.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":25609.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":36415.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":16379.46,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16379.46,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":17503.54,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17021.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":17985.28,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":16700.62,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":15576.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16700.62,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":16379.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":17342.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20072.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12984.77,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":16700.62,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":15255.38,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":16700.62,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":17342.95,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":17664.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16540.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":15303.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":16058.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15576.54,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC ","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":24395.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11481.34,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":11873.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12463.87,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":11537.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":11313.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11313.32,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10386.56,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12321.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":17156.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24395.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":11425.34,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11425.34,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":12209.43,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11873.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":12545.47,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":11649.36,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10865.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11649.36,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":11425.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":12097.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14001.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8698.58,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":11649.36,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":10641.24,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":11649.36,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":12097.41,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":12321.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11537.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10674.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":11201.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10865.27,"methodology":"fee schedule"}]}]},{"description":"Otolaryngologic examination under general anesthesia ","code_information":[{"code":"361","type":"RC"},{"code":"92502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Otolaryngologic examination under general anesthesia ","code_information":[{"code":"499","type":"RC"},{"code":"92502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Otoplasty, protruding ear, with or without size reduction ","code_information":[{"code":"69300","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Otoplasty, protruding ear, with or without size reduction ","code_information":[{"code":"69300","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ovarian cystectomy, unilateral or bilateral ","code_information":[{"code":"361","type":"RC"},{"code":"58925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ovarian cystectomy, unilateral or bilateral ","code_information":[{"code":"499","type":"RC"},{"code":"58925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"OVERTUBE ENDO 25CM ","code_information":[{"code":"907241","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PACK SURG ST TIS BX HAZ ","code_information":[{"code":"823307","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":523.00,"discounted_cash":523.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":86.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":39.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":99.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":75.31,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":94.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":130.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":115.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":67.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":43.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":37.66,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":78.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":115.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":104.08,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":418.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":83.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":120.29,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":109.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":177.82,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":120.29,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":88.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":444.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":392.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":48.64,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":67.99,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":418.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":444.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":261.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":70.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":758.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":149.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":235.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":132.32,"methodology":"percent of total billed charges"}]}]},{"description":"PADDING CAST 2.6YD X 2IN ","code_information":[{"code":"916617","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":89.00,"discounted_cash":89.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":17.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":12.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":16.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":22.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":19.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":11.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":7.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":6.41,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":13.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":19.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":71.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":14.24,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":20.47,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":18.69,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":30.26,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":20.47,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":15.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":75.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":66.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":11.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":71.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":75.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":129.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":25.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":40.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":22.52,"methodology":"percent of total billed charges"}]}]},{"description":"PADDING CAST 4IN X 4YD ","code_information":[{"code":"913990","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":186.41,"discounted_cash":186.41,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":30.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":13.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":35.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":26.84,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":33.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":46.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":41.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":24.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":15.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":13.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":27.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":41.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":37.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":149.13,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":29.83,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":42.87,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":39.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":63.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":42.87,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":31.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":158.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":139.81,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":17.34,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":24.23,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":149.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":158.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":93.20,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":25.17,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":270.29,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":53.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":83.88,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":47.16,"methodology":"percent of total billed charges"}]}]},{"description":"Pain management, analysis of 11 endogenous analytes (methymalonic acid, xanthurenic acid, homocysteine, proglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acidm, hydroxymethyglutarate, ethylmalon ","code_information":[{"code":"0117U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":798.62,"maximum":1260.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":865.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":891.09,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1260.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1008.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1050.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":941.53,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":832.24,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":832.24,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1008.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1000.37,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":798.62,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":844.85,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"}]}]},{"description":"Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft) ","code_information":[{"code":"42210","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft) ","code_information":[{"code":"42210","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft) ","code_information":[{"code":"42210","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Palatoplasty for cleft palate; secondary lengthening procedure ","code_information":[{"code":"360","type":"RC"},{"code":"42220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence ","code_information":[{"code":"81307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":642.67,"maximum":1014.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":696.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":717.09,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1014.75,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":811.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":690.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":690.03,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":845.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":744.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":757.68,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":669.74,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":669.74,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":811.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":805.03,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":710.33,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":642.67,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":710.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":744.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":710.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":679.88,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":676.50,"methodology":"fee schedule"}]}]},{"description":"PANCRELIPASE 12000 U PO ","code_information":[{"code":"797459","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":35.00,"discounted_cash":35.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":5.04,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":5.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":7.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.96,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":8.05,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8.05,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":5.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":26.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":3.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.55,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":4.72,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":50.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":9.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":8.86,"methodology":"percent of total billed charges"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous ","code_information":[{"code":"361","type":"RC"},{"code":"65800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection ","code_information":[{"code":"360","type":"RC"},{"code":"65810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Parathyroidectomy or exploration of parathyroid(s); ","code_information":[{"code":"60500","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parathyroidectomy or exploration of parathyroid(s); ","code_information":[{"code":"60500","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parathyroidectomy or exploration of parathyroid(s); re-exploration ","code_information":[{"code":"60502","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parathyroidectomy or exploration of parathyroid(s); re-exploration ","code_information":[{"code":"60502","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach ","code_information":[{"code":"490","type":"RC"},{"code":"57423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach ","code_information":[{"code":"57423","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach ","code_information":[{"code":"57423","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary proced ","code_information":[{"code":"64462","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions ","code_information":[{"code":"11056","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands ","code_information":[{"code":"360","type":"RC"},{"code":"42509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts ","code_information":[{"code":"369","type":"RC"},{"code":"42510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts ","code_information":[{"code":"42510","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts ","code_information":[{"code":"42510","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts ","code_information":[{"code":"42510","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR; WITH MASTOIDECTOMY ","code_information":[{"code":"481","type":"RC"},{"code":"69718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11482.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"}]}]},{"description":"REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR; WITH MASTOIDECTOMY ","code_information":[{"code":"490","type":"RC"},{"code":"69718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11482.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"369","type":"RC"},{"code":"49452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49452","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49450","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49450","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of tissue expander with permanent implant ","code_information":[{"code":"11970","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replacement of tissue expander with permanent implant ","code_information":[{"code":"11970","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system ","code_information":[{"code":"361","type":"RC"},{"code":"62230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access ","code_information":[{"code":"36583","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition ","code_information":[{"code":"43761","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition ","code_information":[{"code":"43761","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and im ","code_information":[{"code":"369","type":"RC"},{"code":"37192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPOSITIONING OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; SENSING LEAD ONLY ","code_information":[{"code":"0433T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular lead) ","code_information":[{"code":"0415T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular lead) ","code_information":[{"code":"0415T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; ","code_information":[{"code":"58950","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; ","code_information":[{"code":"58950","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection of elbow joint (arthrectomy) ","code_information":[{"code":"24155","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls ","code_information":[{"code":"361","type":"RC"},{"code":"42892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls ","code_information":[{"code":"42892","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Resection of palate or extensive resection of lesion ","code_information":[{"code":"361","type":"RC"},{"code":"42120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection of scrotum ","code_information":[{"code":"369","type":"RC"},{"code":"55150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection or transplantation of long tendon of biceps ","code_information":[{"code":"23440","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection, condyle(s), distal end of phalanx, each toe ","code_information":[{"code":"28153","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection, condyle(s), distal end of phalanx, each toe ","code_information":[{"code":"28153","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection, condyle(s), distal end of phalanx, each toe ","code_information":[{"code":"28153","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection, partial or complete, phalangeal base, each toe ","code_information":[{"code":"28126","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection, partial or complete, phalangeal base, each toe ","code_information":[{"code":"28126","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"RESP FLOW VOLUME LOOP ","code_information":[{"code":"122025","type":"CDM"},{"code":"94375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":709.00,"discounted_cash":709.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":116.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":135.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":102.10,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":127.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":177.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":155.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":92.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":106.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":156.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":141.09,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":567.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":113.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":163.07,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":148.89,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":241.06,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":163.07,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":120.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":602.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":531.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":65.94,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":92.17,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":567.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":602.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":95.72,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1028.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":202.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":319.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":179.38,"methodology":"percent of total billed charges"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH CC ","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":21355.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10222.60,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10571.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10911.05,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10272.46,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10073.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10073.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9092.54,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10970.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":15018.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21355.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10172.73,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10172.73,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10870.86,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10571.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11170.06,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":10372.19,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9674.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10372.19,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10172.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":10771.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12466.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7614.86,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10372.19,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":9474.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10372.19,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":10771.13,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10970.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10272.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9504.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":9973.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9674.07,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":12684.22,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6631.19,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":6857.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6480.58,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":6663.54,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":6534.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6534.15,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5400.49,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7116.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":8920.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12684.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":6598.85,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6598.85,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":7051.71,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6857.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":7245.79,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":6728.23,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6275.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6728.23,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":6598.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6987.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8086.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4522.82,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6728.23,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":6145.98,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6728.23,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":6987.01,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":7116.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6663.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6165.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":6469.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6275.37,"methodology":"fee schedule"}]}]},{"description":"RETRACTOR SUCTION DISP ","code_information":[{"code":"923355","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2365.00,"discounted_cash":2365.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":390.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":177.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":451.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":340.56,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":425.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":591.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":520.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":307.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":196.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":170.28,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":354.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":522.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":470.63,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1892.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":378.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":543.95,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":496.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":804.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":543.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":402.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2010.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1773.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":219.94,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":307.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1892.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2010.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1182.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":319.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3429.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":674.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1064.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":598.35,"methodology":"percent of total billed charges"}]}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, ","code_information":[{"code":"37193","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, ","code_information":[{"code":"37193","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; alcohol ","code_information":[{"code":"67505","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; alcohol ","code_information":[{"code":"67505","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; medication (separate procedure, does not include supply of medication) ","code_information":[{"code":"361","type":"RC"},{"code":"67500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; medication (separate procedure, does not include supply of medication) ","code_information":[{"code":"499","type":"RC"},{"code":"67500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"RETRVL IVC FILTER W IMAG ","code_information":[{"code":"595824","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":68290.00,"discounted_cash":68290.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":5121.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12292.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5668.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4916.88,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":10243.50,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":54632.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":10926.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":15706.70,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":15706.70,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":11609.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":58046.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":51217.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6350.97,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":54632.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":58046.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":34145.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":9219.15,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":99020.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":30730.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":17277.37,"methodology":"percent of total billed charges"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37225","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37225","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty ","code_information":[{"code":"37224","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when ","code_information":[{"code":"369","type":"RC"},{"code":"37227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed ","code_information":[{"code":"361","type":"RC"},{"code":"37226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37226","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"37222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37221","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37221","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed ","code_information":[{"code":"369","type":"RC"},{"code":"37229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same v ","code_information":[{"code":"361","type":"RC"},{"code":"37231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same v ","code_information":[{"code":"37231","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when perf ","code_information":[{"code":"37230","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary proced ","code_information":[{"code":"361","type":"RC"},{"code":"37232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision (including removal) of prosthetic vaginal graft, laparoscopic approach ","code_information":[{"code":"369","type":"RC"},{"code":"57426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision (including removal) of prosthetic vaginal graft; vaginal approach ","code_information":[{"code":"57295","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"63663","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in complete mastoidectomy ","code_information":[{"code":"481","type":"RC"},{"code":"69601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in radical mastoidectomy ","code_information":[{"code":"360","type":"RC"},{"code":"69603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in tympanoplasty ","code_information":[{"code":"69604","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"REVISION MASTOIDECTOMY; WITH APICECTOMY ","code_information":[{"code":"369","type":"RC"},{"code":"69605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft ","code_information":[{"code":"360","type":"RC"},{"code":"66185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft ","code_information":[{"code":"490","type":"RC"},{"code":"66184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of arthroplasty, including removal of implant, wrist joint ","code_information":[{"code":"25449","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of arthroplasty, including removal of implant, wrist joint ","code_information":[{"code":"25449","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; simple (release of superficial scar) (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"44340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of ileostomy; simple (release of superficial scar) (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"44312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of implanted intra-arterial infusion pump ","code_information":[{"code":"36261","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of implanted intra-arterial infusion pump ","code_information":[{"code":"36261","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of implanted intra-arterial infusion pump ","code_information":[{"code":"36261","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REVISION OF LARYNX ","code_information":[{"code":"31582","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"REVISION OF LARYNX ","code_information":[{"code":"31588","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy ","code_information":[{"code":"19370","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of peritoneal-venous shunt ","code_information":[{"code":"49426","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue exc ","code_information":[{"code":"19380","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of stapedectomy or stapedotomy ","code_information":[{"code":"361","type":"RC"},{"code":"69662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component ","code_information":[{"code":"24370","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revision of tracheostomy scar ","code_information":[{"code":"31830","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of tracheostomy scar ","code_information":[{"code":"31830","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannu ","code_information":[{"code":"37183","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":11895.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recannu ","code_information":[{"code":"37183","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revision of urinary-cutaneous anastomosis (any type urostomy); ","code_information":[{"code":"481","type":"RC"},{"code":"50727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of urinary-cutaneous anastomosis (any type urostomy); ","code_information":[{"code":"490","type":"RC"},{"code":"50727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed) ","code_information":[{"code":"0271T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed) ","code_information":[{"code":"0271T","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and r ","code_information":[{"code":"0269T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and r ","code_information":[{"code":"0269T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of cranial neurostimulator pulse generator or receiver ","code_information":[{"code":"360","type":"RC"},{"code":"61888","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"63688","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"63688","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of intracranial neurostimulator electrodes ","code_information":[{"code":"490","type":"RC"},{"code":"61880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of peripheral neurostimulator electrode array ","code_information":[{"code":"481","type":"RC"},{"code":"64585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of peripheral neurostimulator electrode array ","code_information":[{"code":"490","type":"RC"},{"code":"64585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"361","type":"RC"},{"code":"64595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"499","type":"RC"},{"code":"64595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"64595","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure ","code_information":[{"code":"360","type":"RC"},{"code":"66250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator ","code_information":[{"code":"361","type":"RC"},{"code":"64569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator ","code_information":[{"code":"64569","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium) ","code_information":[{"code":"35883","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium) ","code_information":[{"code":"35883","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition ","code_information":[{"code":"35881","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty ","code_information":[{"code":"35879","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only ","code_information":[{"code":"30460","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies ","code_information":[{"code":"30462","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip ","code_information":[{"code":"30410","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; including major septal repair ","code_information":[{"code":"30420","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; including major septal repair ","code_information":[{"code":"30420","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip ","code_information":[{"code":"30400","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip ","code_information":[{"code":"30400","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip ","code_information":[{"code":"30400","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) ","code_information":[{"code":"30450","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Rhinoplasty, secondary; minor revision (small amount of nasal tip work) ","code_information":[{"code":"30430","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; cheek, chin, and neck ","code_information":[{"code":"15828","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; forehead ","code_information":[{"code":"15824","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; glabellar frown lines ","code_information":[{"code":"15826","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap ","code_information":[{"code":"15829","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report ","code_information":[{"code":"369","type":"RC"},{"code":"C9741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES ","code_information":[{"code":"369","type":"RC"},{"code":"93530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES ","code_information":[{"code":"481","type":"RC"},{"code":"93530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"RING EX FIX LONG 155MM ","code_information":[{"code":"872450","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":12442.00,"discounted_cash":12442.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":2052.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":933.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2376.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":1791.65,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2239.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3110.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2737.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1617.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1032.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":895.82,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1866.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":2749.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2475.96,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9953.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1990.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2861.66,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":2612.82,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":4230.28,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2861.66,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2115.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10575.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9331.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1157.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1617.46,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9953.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10575.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6221.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1679.67,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":18040.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":3545.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5598.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3147.83,"methodology":"percent of total billed charges"}]}]},{"description":"RM & BD PRIVATE ADJ ","code_information":[{"code":"2532","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2940.00,"discounted_cash":2940.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":485.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":220.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":561.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":423.36,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":529.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":735.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":646.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":244.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":211.68,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":441.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":649.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":585.06,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2352.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":470.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":676.20,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":617.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":999.60,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":676.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":499.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2499.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2205.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":273.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2352.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2499.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1470.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":396.90,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4263.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":837.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1323.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":743.82,"methodology":"percent of total billed charges"}]}]},{"description":"RM & BD SEMI PRIVATE ADJ ","code_information":[{"code":"1586","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2943.00,"discounted_cash":2943.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":485.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":220.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":562.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":423.79,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":529.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":735.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":647.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":244.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":211.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":441.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":650.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":585.66,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2354.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":470.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":676.89,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1000.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":676.89,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":500.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2501.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2207.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":273.70,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.59,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2354.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2501.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1471.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":397.31,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4267.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":838.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1324.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":744.58,"methodology":"percent of total billed charges"}]}]},{"description":"RM & BD SEMI PRIVATE ADJ ","code_information":[{"code":"2877","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":7983.00,"discounted_cash":7983.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":1317.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":598.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1524.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":1149.55,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1436.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1995.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1756.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1037.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":662.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":574.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1197.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1764.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1588.62,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6386.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1277.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1836.09,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1676.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2714.22,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1836.09,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1357.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6785.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5987.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":742.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1037.79,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6386.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6785.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3991.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1077.70,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":11575.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2275.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3592.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2019.70,"methodology":"percent of total billed charges"}]}]},{"description":"ROD CFBR EX FIX MED160X8 ","code_information":[{"code":"827789","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"ROD CFBRFIX MED 400X8 ","code_information":[{"code":"884604","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"ROD EXFX 11X400MM ","code_information":[{"code":"861465","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3419.00,"discounted_cash":3419.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":564.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":256.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":653.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":492.34,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":615.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":854.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":752.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":444.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":283.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":246.17,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":512.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":755.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":680.38,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2735.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":547.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":786.37,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":717.99,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1162.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":786.37,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":581.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2906.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2564.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":317.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":444.47,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2735.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2906.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1709.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":461.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4957.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":974.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1538.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":865.01,"methodology":"percent of total billed charges"}]}]},{"description":"ROD THRD 200MM EXFX ","code_information":[{"code":"847875","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"RPD REFL CONT INJ SYST ","code_information":[{"code":"824656","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":203.00,"discounted_cash":203.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":33.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":15.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":38.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":29.23,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":36.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":50.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":44.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.39,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":16.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":14.62,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":30.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":44.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":40.40,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":162.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":32.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":46.69,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":69.02,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.69,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":34.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":172.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":152.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":18.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.39,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":162.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":172.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":27.41,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":294.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":57.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":91.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":51.36,"methodology":"percent of total billed charges"}]}]},{"description":"Russell viper venom time (includes venom); diluted ","code_information":[{"code":"798440","type":"CDM"},{"code":"85613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.10,"maximum":14.37,"gross_charge":1.00,"discounted_cash":1.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":11.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":9.10,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.58,"methodology":"fee schedule"}]}]},{"description":"Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"58700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"58720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"58720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) ","code_information":[{"code":"58720","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Salpingostomy (salpingoneostomy) ","code_information":[{"code":"369","type":"RC"},{"code":"58770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Salpingostomy (salpingoneostomy) ","code_information":[{"code":"481","type":"RC"},{"code":"58770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Salpingostomy (salpingoneostomy) ","code_information":[{"code":"490","type":"RC"},{"code":"58770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"SC DIL/BIL WO/STENT ","code_information":[{"code":"115860","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":23353.00,"discounted_cash":23353.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1751.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4203.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1938.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1681.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":3502.95,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18682.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":3736.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5371.19,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5371.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":3970.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19850.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":17514.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2171.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18682.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19850.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":3152.66,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":33861.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10508.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":5908.31,"methodology":"percent of total billed charges"}]}]},{"description":"SC DIL/BILIARY W/STENT ","code_information":[{"code":"115859","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":23353.00,"discounted_cash":23353.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1751.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4203.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1938.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1681.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":3502.95,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18682.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":3736.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5371.19,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5371.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":3970.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19850.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":17514.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2171.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":18682.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19850.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11676.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":3152.66,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":33861.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10508.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":5908.31,"methodology":"percent of total billed charges"}]}]},{"description":"SC EXCHANGE CATH ART ","code_information":[{"code":"115960","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":78974.00,"discounted_cash":78974.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":5923.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14215.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":6554.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":5686.13,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":11846.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":63179.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":12635.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":18164.02,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":18164.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":13425.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":67127.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":59230.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":7344.58,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":63179.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":67127.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39487.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":10661.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":114512.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":35538.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":19980.42,"methodology":"percent of total billed charges"}]}]},{"description":"SC INS TNLD PLEUR CATH ","code_information":[{"code":"116218","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":30003.00,"discounted_cash":30003.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2250.22,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5400.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2490.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2160.22,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":4500.45,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24002.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":4800.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":6900.69,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6900.69,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":5100.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25502.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":22502.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2790.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24002.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25502.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15001.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":4050.41,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":43504.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13501.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":7590.76,"methodology":"percent of total billed charges"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve ","code_information":[{"code":"64712","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty; digital, 1 or both, same digit ","code_information":[{"code":"369","type":"RC"},{"code":"64702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty; nerve of hand or foot ","code_information":[{"code":"499","type":"RC"},{"code":"64704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"NEUROSTIM WRLS EXTRNL ","code_information":[{"code":"896145","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ºCOVID-19»); screen ","code_information":[{"code":"86408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40.02,"maximum":63.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":44.66,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":63.20,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":52.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":40.02,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":42.34,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.13,"methodology":"fee schedule"}]}]},{"description":"Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct ","code_information":[{"code":"19110","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nipple/areola reconstruction ","code_information":[{"code":"19350","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nocturnal penile tumescence and/or rigidity test ","code_information":[{"code":"499","type":"RC"},{"code":"54250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC ","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":67383.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29285.40,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":30285.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":34427.48,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":29428.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":28856.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28856.83,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":28689.57,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31428.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47388.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":67383.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":29142.54,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29142.54,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":31142.52,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30285.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":31999.65,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":29713.96,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":27713.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29713.96,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":29142.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":30856.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35713.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24027.08,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":29713.96,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":27142.56,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":29713.96,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":30856.81,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":31428.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29428.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":27228.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":28571.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27713.99,"methodology":"fee schedule"}]}]},{"description":"Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervi ","code_information":[{"code":"360","type":"RC"},{"code":"36221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"NUT EX FIX 10MM ","code_information":[{"code":"835288","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2044.00,"discounted_cash":2044.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":337.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":153.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":390.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":294.34,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":367.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":511.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":449.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":265.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":169.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":147.17,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":306.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":451.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":406.76,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1635.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":327.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":470.12,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":429.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":694.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":470.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":347.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1737.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1533.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":190.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":265.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1635.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1737.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1022.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":275.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2963.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":582.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":919.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":517.13,"methodology":"percent of total billed charges"}]}]},{"description":"Obstetric panel (includes HIV testing) This panel must include the following: Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC ","code_information":[{"code":"80081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71.12,"maximum":112.29,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":77.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":80.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":79.35,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":76.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":76.36,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":93.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":80.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":80.10,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":83.84,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":74.11,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":74.11,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":74.53,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":89.08,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":78.60,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":71.12,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":78.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":78.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":75.23,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":74.86,"methodology":"fee schedule"}]}]},{"description":"Obstetrics (preeclampsia), kinase insert domain receptor, Endoglin, and retinol-binding protein 4, by immunoassay, serum, algorithm reported as a risk score ","code_information":[{"code":"0390U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61.19,"maximum":96.61,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":72.14,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":63.77,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":63.77,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":76.65,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"OBTURATOR BLDLSS 8MM ","code_information":[{"code":"897879","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":975.00,"discounted_cash":975.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":160.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":73.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":186.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":140.40,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":175.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":243.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":214.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":126.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":80.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":70.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":146.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":215.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":194.03,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":780.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":156.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":224.25,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":204.75,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":331.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":224.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":165.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":828.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":731.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":90.67,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":126.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":780.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":828.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":487.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":131.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1413.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":277.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":438.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":246.68,"methodology":"percent of total billed charges"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"369","type":"RC"},{"code":"58615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; amniotic membrane transplantation, multiple layers ","code_information":[{"code":"360","type":"RC"},{"code":"65780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) ","code_information":[{"code":"369","type":"RC"},{"code":"65782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor) ","code_information":[{"code":"369","type":"RC"},{"code":"65781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Onc Brst CA Image Alys w/ AI Assmt 12 Features ","code_information":[{"code":"0220U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":670.94,"maximum":1059.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":727.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":748.63,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1059.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":847.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":882.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":791.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":699.19,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":699.19,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":847.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":840.44,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":741.56,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":670.94,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":741.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":741.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":709.78,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"}]}]},{"description":"Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissu ","code_information":[{"code":"0120U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2384.70,"maximum":3765.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2585.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2685.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2660.82,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3765.32,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":2560.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2560.41,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":3137.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2761.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2685.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2685.92,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2811.44,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2485.11,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2485.11,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2987.15,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":2635.72,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":2384.70,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":2635.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2761.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":2635.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":2522.76,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), immunohistochemistry, protein expression profiling of 4 biomarkers (matrix metalloproteinase-1 [MMP-1], carcinoembryonic antigen-related cell adhesion molecule 6 [CEACAM6], hyaluron ","code_information":[{"code":"0067U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1802.15,"maximum":2845.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1953.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2029.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2010.82,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2845.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":2276.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":1934.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1934.94,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2371.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2086.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2029.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2029.79,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2124.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1878.03,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1878.03,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2276.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2257.43,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":1991.85,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":1802.15,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":1991.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2086.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":1991.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":1906.48,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1897.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1897.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score ","code_information":[{"code":"81519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool ","code_information":[{"code":"81528","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":483.43,"maximum":763.31,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":524.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":544.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":539.40,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":763.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":610.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":519.05,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":636.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":559.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":544.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":544.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":569.93,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":503.78,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":503.78,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":506.63,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":610.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":605.56,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":534.31,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":483.43,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":534.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":559.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":534.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":511.41,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":508.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":508.87,"methodology":"fee schedule"}]}]},{"description":"Oncology (pan-cancer), analysis of MRD from plasma, with assays personalized to each patient based on prior next generation sequencing of the patient's tumor and germline DNA, reported as absence or p ","code_information":[{"code":"0340U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3410.50,"maximum":5385.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3697.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":3841.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":3805.40,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5385.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4308.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3661.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3661.80,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4900.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3949.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":3841.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3841.30,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4020.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3554.10,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3554.10,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4308.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4272.10,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":3769.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3410.50,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":3769.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":3949.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":3769.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3607.95,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3590.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3590.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score ","code_information":[{"code":"81542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (Solid Tumor), circulating tumor cell selection, id, morphological characterization, detection and enumeration based on differential EpCAM, cytokeratins 8, 18 and 19, and CD45 protein biomark ","code_information":[{"code":"0338U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2313.25,"maximum":3652.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2508.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2605.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2581.10,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3652.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":2922.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":2483.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2483.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2678.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2605.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2605.45,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2727.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2410.65,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2410.65,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":2424.30,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2922.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2897.65,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":2556.75,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":2313.25,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":2556.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2678.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":2556.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":2447.17,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":2435.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2435.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious) ","code_information":[{"code":"81546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3420.00,"maximum":5400.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3708.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":3816.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5400.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4320.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4032.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3564.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3564.00,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4320.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4284.00,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3420.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3618.00,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 ºCDK1», IGFBP5, and CXCR2), utilizing urine, algorithm reported as a risk score fo ","code_information":[{"code":"0013M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":1140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":782.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":851.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":904.40,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology, response to radiation, cell-free DNA, quantitative branched chain DNA amplfication, plasma, reported as a radiation toxicity score ","code_information":[{"code":"0285U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":421.14,"maximum":664.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":456.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":664.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":531.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":452.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":452.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":496.51,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":438.88,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":438.88,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":531.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":527.54,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":465.48,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":421.14,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":465.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":465.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":445.53,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":443.31,"methodology":"fee schedule"}]}]},{"description":"Oncology, spheroid cell culture in 3D microenvironment, 12 drug panel, response prediction for each drug ","code_information":[{"code":"0248U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2882.17,"maximum":4550.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3124.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":3246.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":3215.89,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4550.79,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":3640.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3094.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3094.54,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":3792.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3337.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":3246.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3246.23,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":3397.92,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3003.52,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3003.52,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3640.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3610.29,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":3185.55,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":2882.17,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":3185.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":3337.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":3185.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3049.03,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3033.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3033.86,"methodology":"fee schedule"}]}]},{"description":"Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, ","code_information":[{"code":"360","type":"RC"},{"code":"58943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"OP VISIT LEVEL 5 EST ","code_information":[{"code":"122860","type":"CDM"},{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2744.00,"discounted_cash":2744.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":452.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":524.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":395.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":493.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1372.00,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1372.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1372.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2195.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":631.12,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2332.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2058.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":356.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1372.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2195.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2332.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1372.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":782.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1234.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":694.23,"methodology":"percent of total billed charges"}]}]},{"description":"Open implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator ","code_information":[{"code":"64568","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Open implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) ","code_information":[{"code":"64575","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) ","code_information":[{"code":"499","type":"RC"},{"code":"64581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Open osteochondral autograft, talus (includes obtaining graftºs») ","code_information":[{"code":"28446","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open osteochondral autograft, talus (includes obtaining graftºs») ","code_information":[{"code":"28446","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting ","code_information":[{"code":"22319","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting ","code_information":[{"code":"22319","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting ","code_information":[{"code":"22319","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting ","code_information":[{"code":"22318","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical ","code_information":[{"code":"22326","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical ","code_information":[{"code":"22326","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment ","code_information":[{"code":"22328","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar ","code_information":[{"code":"22325","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic ","code_information":[{"code":"22327","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic ","code_information":[{"code":"22327","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse ","code_information":[{"code":"27228","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse ","code_information":[{"code":"27228","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse ","code_information":[{"code":"27228","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation ","code_information":[{"code":"27227","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acromioclavicular dislocation, acute or chronic; ","code_information":[{"code":"23550","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft) ","code_information":[{"code":"23552","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft) ","code_information":[{"code":"23552","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of acute shoulder dislocation ","code_information":[{"code":"23660","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation ","code_information":[{"code":"27846","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation ","code_information":[{"code":"27846","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes pubic symphysis ","code_information":[{"code":"27217","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed ","code_information":[{"code":"27814","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; ","code_information":[{"code":"28415","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) ","code_information":[{"code":"28420","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) ","code_information":[{"code":"28420","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed ","code_information":[{"code":"25628","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduction ","code_information":[{"code":"26686","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint ","code_information":[{"code":"26685","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal fixation, when performed ","code_information":[{"code":"26665","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of clavicular fracture, includes internal fixation, when performed ","code_information":[{"code":"23515","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of coccygeal fracture ","code_information":[{"code":"27202","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft) ","code_information":[{"code":"21366","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical ap ","code_information":[{"code":"21365","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints ","code_information":[{"code":"21470","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints ","code_information":[{"code":"21470","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints ","code_information":[{"code":"21470","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of depressed zygomatic arch fracture (eg, Gillies approach) ","code_information":[{"code":"21356","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed ","code_information":[{"code":"27792","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each ","code_information":[{"code":"26765","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation ","code_information":[{"code":"25607","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments ","code_information":[{"code":"25609","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal radioulnar dislocation, acute or chronic ","code_information":[{"code":"25676","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal radioulnar dislocation, acute or chronic ","code_information":[{"code":"25676","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal radioulnar dislocation, acute or chronic ","code_information":[{"code":"25676","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed ","code_information":[{"code":"27829","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed ","code_information":[{"code":"27829","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed ","code_information":[{"code":"27829","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of femoral shaft fracture with plate/screws, with or without cerclage ","code_information":[{"code":"27507","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of femoral shaft fracture with plate/screws, with or without cerclage ","code_information":[{"code":"27507","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed ","code_information":[{"code":"27513","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when performed ","code_information":[{"code":"27511","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of orbit, except blowout; with implant ","code_information":[{"code":"21407","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of orbit, except blowout; with implant ","code_information":[{"code":"21407","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of orbit, except blowout; without implant ","code_information":[{"code":"21406","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula ","code_information":[{"code":"27828","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula ","code_information":[{"code":"27828","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula ","code_information":[{"code":"27828","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only ","code_information":[{"code":"27826","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only ","code_information":[{"code":"27826","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only ","code_information":[{"code":"27826","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Dilation of urethral stricture by passage of filiform and follower, male; initial ","code_information":[{"code":"53620","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; initial ","code_information":[{"code":"53600","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent ","code_information":[{"code":"369","type":"RC"},{"code":"53601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or conduction (spinal) anesthesia ","code_information":[{"code":"481","type":"RC"},{"code":"53605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Dilation salivary duct ","code_information":[{"code":"42650","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"DILATOR 10F 20CM ","code_information":[{"code":"923296","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":248.00,"discounted_cash":248.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":40.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":18.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":47.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":35.71,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":44.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":62.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":54.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":20.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":17.86,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":37.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":54.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":49.35,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":198.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":39.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":57.04,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":84.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":57.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":42.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":210.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":186.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":23.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":198.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":210.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":33.48,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":359.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":70.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":111.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":62.74,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR BLN 8X180CM ","code_information":[{"code":"822322","type":"CDM"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR SHEATH PLWY 20FR ","code_information":[{"code":"850830","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR URET 4CM 70CM ","code_information":[{"code":"808974","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR VASC 9FR 20CM ","code_information":[{"code":"840223","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":286.00,"discounted_cash":286.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":47.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":21.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":54.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":41.18,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":51.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":71.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":37.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":23.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":20.59,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":42.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":63.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.91,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":228.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":45.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":65.78,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":97.24,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":65.78,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":48.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":243.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":214.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":37.18,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":228.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":243.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":143.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":414.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":81.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":128.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":72.36,"methodology":"percent of total billed charges"}]}]},{"description":"Disarticulation of shoulder; secondary closure or scar revision ","code_information":[{"code":"23921","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure ","code_information":[{"code":"369","type":"RC"},{"code":"63076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure ","code_information":[{"code":"490","type":"RC"},{"code":"63076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages) ","code_information":[{"code":"360","type":"RC"},{"code":"66821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife) ","code_information":[{"code":"369","type":"RC"},{"code":"66820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL ","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":19716.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16167.38,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":16719.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1684.42,"methodology":"fee schedule","additional_payer_notes":"Days 1. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":18244.70,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":16246.24,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":15930.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15930.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15203.92,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17350.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":16088.51,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16088.51,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":17192.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16719.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":17665.82,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":16403.97,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":15299.86,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16403.97,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":16088.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":17034.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19716.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12733.05,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":16403.97,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":14984.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":16403.97,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":17034.89,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":17350.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16246.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":15031.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":15773.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15299.86,"methodology":"fee schedule"}]}]},{"description":"Dissection, deep jugular node(s) ","code_information":[{"code":"369","type":"RC"},{"code":"38542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Division of scalenus anticus; without resection of cervical rib ","code_information":[{"code":"21700","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Division of sternocleidomastoid for torticollis, open operation; with cast application ","code_information":[{"code":"21725","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Division of sternocleidomastoid for torticollis, open operation; without cast application ","code_information":[{"code":"21720","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size) ","code_information":[{"code":"81239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261.09,"maximum":412.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":283.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":412.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":343.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":307.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":327.05,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"}]}]},{"description":"DRAIN INCS 5/8IN 12IN ","code_information":[{"code":"924282","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":26.00,"discounted_cash":26.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":4.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":3.74,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":3.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":5.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":5.17,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":20.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":4.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5.98,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5.98,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":4.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.38,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":20.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":3.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":37.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":7.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":6.58,"methodology":"percent of total billed charges"}]}]},{"description":"DRAIN WND RND HBLS 15FR ","code_information":[{"code":"840567","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1015.00,"discounted_cash":1015.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":167.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":76.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":193.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":146.16,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":182.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":253.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":223.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":131.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":84.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":73.08,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":152.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":224.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":201.99,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":812.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":162.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":233.45,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":213.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":345.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":233.45,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":172.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":862.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":761.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":94.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":131.95,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":812.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":862.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":507.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":137.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1471.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":289.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":456.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":256.80,"methodology":"percent of total billed charges"}]}]},{"description":"Drainage abscess or hematoma, nasal septum ","code_information":[{"code":"30020","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Drainage abscess or hematoma, nasal, internal approach ","code_information":[{"code":"30000","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Drainage external auditory canal, abscess ","code_information":[{"code":"69020","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Drainage external ear, abscess or hematoma; simple ","code_information":[{"code":"360","type":"RC"},{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Drainage of abscess, cyst, hematoma from dentoalveolar structures ","code_information":[{"code":"41800","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Drainage of abscess; parotid, complicated ","code_information":[{"code":"361","type":"RC"},{"code":"42305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Drainage of abscess; parotid, simple ","code_information":[{"code":"42300","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Drainage of deep periurethral abscess ","code_information":[{"code":"360","type":"RC"},{"code":"53040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Drainage of finger abscess; complicated (eg, felon) ","code_information":[{"code":"26011","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Drainage of lymph node abscess or lymphadenitis; simple ","code_information":[{"code":"369","type":"RC"},{"code":"38300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach ","code_information":[{"code":"360","type":"RC"},{"code":"58800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Drainage of palmar bursa; single, bursa ","code_information":[{"code":"26025","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Drainage of perineal urinary extravasation; uncomplicated (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"53080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Drainage of scrotal wall abscess ","code_information":[{"code":"55100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Drainage of Skene's gland abscess or cyst ","code_information":[{"code":"360","type":"RC"},{"code":"53060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Drainage of tendon sheath, digit and/or palm, each ","code_information":[{"code":"26020","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"DRESSING NASAL DISOLVABL ","code_information":[{"code":"830837","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRESSING WND 2X2IN ","code_information":[{"code":"937701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":557.00,"discounted_cash":557.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":91.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":41.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":106.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":80.21,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":100.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":139.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":122.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":72.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":46.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":40.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":83.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":123.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":110.84,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":445.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":89.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":128.11,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":189.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":128.11,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":94.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":473.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":417.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":51.80,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":72.41,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":445.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":473.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":278.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":75.19,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":807.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":158.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":250.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":140.92,"methodology":"percent of total billed charges"}]}]},{"description":"DRESSING WND AG 4X5IN ","code_information":[{"code":"922896","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":204.00,"discounted_cash":204.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":33.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":15.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":38.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":29.38,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":36.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":51.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":44.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":16.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":30.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":45.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":40.60,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":163.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":32.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":46.92,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":69.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":34.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":173.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":18.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.52,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":163.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":173.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":27.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":295.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":58.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":91.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":51.61,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL BIT 2MM SCR 2.7MM ","code_information":[{"code":"861366","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL BIT 3.5MM 200MM ","code_information":[{"code":"828437","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2807.00,"discounted_cash":2807.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":463.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":210.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":536.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":404.21,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":505.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":701.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":617.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":364.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":232.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":202.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":421.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":620.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":558.59,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2245.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":449.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":645.61,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":589.47,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":954.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":645.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":477.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2385.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2105.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":261.05,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":364.91,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2245.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2385.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1403.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":378.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4070.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":800.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1263.15,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":710.17,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL BIT CANN 4MM STRL ","code_information":[{"code":"872366","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL FOR 2.4MM ","code_information":[{"code":"876704","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1688.00,"discounted_cash":1688.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":278.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":126.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":322.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":243.07,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":303.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":422.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":371.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":140.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":121.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":253.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":373.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":335.91,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":270.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":573.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":286.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1266.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":156.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":227.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2447.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":481.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":759.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":427.06,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SRG QRLS MRK 2MM ","code_information":[{"code":"881782","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG 2.0MM ","code_information":[{"code":"891390","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1688.00,"discounted_cash":1688.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":278.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":126.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":322.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":243.07,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":303.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":422.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":371.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":140.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":121.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":253.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":373.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":335.91,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":270.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":573.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":286.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1266.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":156.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":227.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2447.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":481.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":759.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":427.06,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG CANN 3.5MM ","code_information":[{"code":"877885","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG CANN 4.5MM ","code_information":[{"code":"938822","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4078.00,"discounted_cash":4078.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":672.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":305.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":778.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":587.23,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":734.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1019.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":897.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":530.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":338.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":293.62,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":611.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":901.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":811.52,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3262.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":652.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":937.94,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":856.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1386.52,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":937.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":693.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3466.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3058.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":379.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":530.14,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3262.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3466.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2039.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":550.53,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5913.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1162.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1835.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1031.73,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG DISP 4.75MM ","code_information":[{"code":"923035","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG SHRT ","code_information":[{"code":"867664","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2250.00,"discounted_cash":2250.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":371.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":168.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":429.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":324.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":405.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":562.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":495.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":186.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":162.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":337.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":497.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":447.75,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1800.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":360.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":517.50,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":765.00,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":517.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":382.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1912.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1687.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":209.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1800.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1912.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1125.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":303.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3262.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":641.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1012.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":569.25,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL SURG SM SHRT 2MM ","code_information":[{"code":"908635","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1688.00,"discounted_cash":1688.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":278.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":126.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":322.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":243.07,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":303.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":422.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":371.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":140.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":121.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":253.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":373.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":335.91,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":270.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":354.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":573.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":388.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":286.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1266.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":156.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":219.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1350.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1434.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":844.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":227.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2447.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":481.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":759.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":427.06,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL TWIST 2MM 91MM ","code_information":[{"code":"851225","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRILL TWST 66X1.2MM ","code_information":[{"code":"884427","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRIVER T7 CANN LAG SCRW ","code_information":[{"code":"932053","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3101.00,"discounted_cash":3101.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":511.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":232.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":592.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":446.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":558.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":775.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":682.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":403.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":257.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":223.27,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":465.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":685.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":617.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2480.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":496.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":713.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":651.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1054.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":713.23,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":527.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2635.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2325.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":288.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":403.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2480.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2635.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1550.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":418.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4496.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":883.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1395.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":784.55,"methodology":"percent of total billed charges"}]}]},{"description":"DRLL BT HMRL 2.0X110MM ","code_information":[{"code":"865927","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1548.00,"discounted_cash":1548.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":255.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":116.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":295.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":222.91,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":278.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":340.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":201.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":128.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":111.46,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":232.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":342.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":308.05,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1238.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":247.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":356.04,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":325.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":526.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":356.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":263.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1315.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1161.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":143.96,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":201.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1238.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1315.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":774.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":208.98,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2244.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":441.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":696.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":391.64,"methodology":"percent of total billed charges"}]}]},{"description":"DRSG WND 3.5X10IN ","code_information":[{"code":"926724","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":830.00,"discounted_cash":830.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":136.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":62.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":158.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":119.52,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":149.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":207.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":182.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":107.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":68.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":59.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":124.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":183.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":165.17,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":664.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":132.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":190.90,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":174.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":282.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":190.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":141.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":705.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":622.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":77.19,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":107.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":664.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":705.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":112.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":236.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":373.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":209.99,"methodology":"percent of total billed charges"}]}]},{"description":"DRSG WND SIL 4X3IN ","code_information":[{"code":"810699","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":131.00,"discounted_cash":131.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":21.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":25.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":18.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":23.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":32.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":28.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":17.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":10.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":9.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":19.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":28.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":26.07,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":104.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":20.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":30.13,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":27.51,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":44.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":30.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":22.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":111.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":98.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":12.18,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":17.03,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":104.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":111.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":65.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":17.68,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":189.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":37.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":58.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":33.14,"methodology":"percent of total billed charges"}]}]},{"description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay ºeg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA»), c ","code_information":[{"code":"792790","type":"CDM"},{"code":"80307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":59.03,"maximum":93.21,"gross_charge":1088.00,"discounted_cash":1088.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":273.34,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":93.21,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":74.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":77.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":69.60,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":61.87,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":74.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":73.95,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":62.45,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture) ","code_information":[{"code":"369","type":"RC"},{"code":"43756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"DUP AO/IVC/IV/BPG COMP ","code_information":[{"code":"116822","type":"CDM"},{"code":"93978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5084.00,"discounted_cash":5084.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":915.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1271.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1118.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":660.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":762.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1123.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1011.72,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4067.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":813.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1169.32,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1067.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1728.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1169.32,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":864.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4321.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3813.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":472.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":660.92,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4067.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4321.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2542.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":686.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7371.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1448.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2287.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1286.25,"methodology":"percent of total billed charges"}]}]},{"description":"ECHO 2D W/WOM MODE LTD ","code_information":[{"code":"121918","type":"CDM"},{"code":"93308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2788.00,"discounted_cash":2788.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":501.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":697.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":613.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":362.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":418.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":616.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":554.81,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2230.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":446.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":641.24,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":585.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":947.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":641.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":473.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2369.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2091.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":259.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":362.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2230.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2369.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1394.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":376.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4042.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":794.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1254.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":705.36,"methodology":"percent of total billed charges"}]}]},{"description":"EEG CEREB DEATH ","code_information":[{"code":"121848","type":"CDM"},{"code":"95824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1353.00,"discounted_cash":1353.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":223.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":258.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":194.83,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":243.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":338.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":297.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":175.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":202.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":299.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":269.25,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1082.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":216.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":311.19,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":284.13,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":460.02,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":311.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":230.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1150.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1014.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":125.83,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":175.89,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1082.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1150.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":182.66,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1961.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":385.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":608.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":342.31,"methodology":"percent of total billed charges"}]}]},{"description":"EEG REC AW & ASLEEP ","code_information":[{"code":"121846","type":"CDM"},{"code":"95819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":958.00,"discounted_cash":958.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":158.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":182.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":137.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":172.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":239.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":210.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":124.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":143.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":211.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":190.64,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":766.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":153.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":220.34,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":325.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":220.34,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":162.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":814.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":718.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":89.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":124.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":766.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":814.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":479.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":129.33,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1389.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":273.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":431.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":242.37,"methodology":"percent of total billed charges"}]}]},{"description":"Electrical stimulation to aid bone healing; invasive (operative) ","code_information":[{"code":"20975","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"ELECTRO BALL LEEP 3M ","code_information":[{"code":"916897","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"ELECTRODE KNIFE YLW PE24 ","code_information":[{"code":"916838","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4668.00,"discounted_cash":4668.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":770.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":350.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":891.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":672.19,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":840.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1167.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1026.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":606.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":387.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":336.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":700.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1031.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":928.93,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3734.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":746.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1073.64,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":980.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1587.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1073.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":793.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3967.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3501.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":434.12,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":606.84,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3734.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3967.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2334.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":630.18,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6768.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1330.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2100.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1181.00,"methodology":"percent of total billed charges"}]}]},{"description":"ELECTRODE PCNG 125CM ","code_information":[{"code":"805778","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Electroejaculation ","code_information":[{"code":"55870","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Electrogastrography, diagnostic, transcutaneous; with provocative testing ","code_information":[{"code":"361","type":"RC"},{"code":"91133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation ","code_information":[{"code":"27825","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each ","code_information":[{"code":"28515","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each ","code_information":[{"code":"28510","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of greater trochanteric fracture, without manipulation ","code_information":[{"code":"27246","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; without anesthesia ","code_information":[{"code":"27250","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24577","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24565","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction ","code_information":[{"code":"24505","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation ","code_information":[{"code":"27538","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation ","code_information":[{"code":"27538","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia ","code_information":[{"code":"26770","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28660","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28660","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of knee dislocation; requiring anesthesia ","code_information":[{"code":"27552","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of knee dislocation; without anesthesia ","code_information":[{"code":"27550","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture with interdental fixation ","code_information":[{"code":"21453","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of mandibular fracture; with manipulation ","code_information":[{"code":"21451","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction ","code_information":[{"code":"27762","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, single; without manipulation, each bone ","code_information":[{"code":"26600","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone ","code_information":[{"code":"26607","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia ","code_information":[{"code":"26700","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia ","code_information":[{"code":"28635","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metatarsophalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28630","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of nasal bone fracture with manipulation; without stabilization ","code_information":[{"code":"21315","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of nasal septal fracture, with or without stabilization ","code_information":[{"code":"21337","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint ","code_information":[{"code":"21421","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each ","code_information":[{"code":"26725","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior malleolus fracture; without manipulation ","code_information":[{"code":"27767","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or d ","code_information":[{"code":"27198","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; without manipulation ","code_information":[{"code":"27780","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction ","code_information":[{"code":"23605","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation ","code_information":[{"code":"23600","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia ","code_information":[{"code":"27831","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; without anesthesia ","code_information":[{"code":"27830","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; without manipulation ","code_information":[{"code":"25560","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; without manipulation ","code_information":[{"code":"25560","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial head or neck fracture; without manipulation ","code_information":[{"code":"24650","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation ","code_information":[{"code":"24640","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture; with manipulation ","code_information":[{"code":"25505","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radial shaft fracture; with manipulation ","code_information":[{"code":"25505","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulation ","code_information":[{"code":"25660","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement) ","code_information":[{"code":"23575","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation ","code_information":[{"code":"23665","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of shoulder dislocation, with manipulation; without anesthesia ","code_information":[{"code":"23650","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; without manipulation ","code_information":[{"code":"23520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talotarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28575","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of talus fracture; with manipulation ","code_information":[{"code":"28435","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia ","code_information":[{"code":"28545","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28605","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent ","code_information":[{"code":"21485","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction ","code_information":[{"code":"27532","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction ","code_information":[{"code":"27752","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation ","code_information":[{"code":"25680","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of trimalleolar ankle fracture; without manipulation ","code_information":[{"code":"27816","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); without manipulation ","code_information":[{"code":"24670","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar shaft fracture; with manipulation ","code_information":[{"code":"25535","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of ulnar shaft fracture; without manipulation ","code_information":[{"code":"25530","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction ","code_information":[{"code":"22315","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"CLOSED TX SPINE PROCESS FX ","code_information":[{"code":"22305","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Closure of anal fistula with rectal advancement flap ","code_information":[{"code":"360","type":"RC"},{"code":"46288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of esophagostomy or fistula; cervical approach ","code_information":[{"code":"361","type":"RC"},{"code":"43420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"361","type":"RC"},{"code":"40830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"40830","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Closure of nephrocutaneous or pyelocutaneous fistula ","code_information":[{"code":"369","type":"RC"},{"code":"50520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication ","code_information":[{"code":"57308","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of rectovaginal fistula; vaginal or transanal approach ","code_information":[{"code":"490","type":"RC"},{"code":"57300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure) ","code_information":[{"code":"53520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicouterine fistula; ","code_information":[{"code":"360","type":"RC"},{"code":"51920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula, abdominal approach ","code_information":[{"code":"481","type":"RC"},{"code":"51900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure of vesicovaginal fistula; vaginal approach ","code_information":[{"code":"361","type":"RC"},{"code":"57320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Closure postauricular fistula, mastoid (separate procedure) ","code_information":[{"code":"69700","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Clotting inhibitors or anticoagulants; protein C, antigen ","code_information":[{"code":"117896","type":"CDM"},{"code":"85302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.41,"maximum":18.02,"gross_charge":92.00,"discounted_cash":92.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor II, prothrombin, specific ","code_information":[{"code":"85210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.33,"maximum":19.47,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"CNTRSNK DRL 2.7MM 3MM ","code_information":[{"code":"836838","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2376.00,"discounted_cash":2376.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":392.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":178.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":453.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":342.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":427.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":594.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":522.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":308.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":197.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":171.07,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":356.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":525.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":472.82,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1900.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":380.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":546.48,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":498.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":807.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":546.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":403.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2019.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1782.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":220.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":308.88,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1900.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2019.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1188.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":320.76,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3445.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":677.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1069.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":601.13,"methodology":"percent of total billed charges"}]}]},{"description":"Coagulation time; other methods ","code_information":[{"code":"85348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.27,"maximum":6.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"}]}]},{"description":"Collection of blood specimen from a completely implantable venous access device ","code_information":[{"code":"36591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":10262.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY DX ","code_information":[{"code":"117199","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":12861.00,"discounted_cash":12861.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":964.58,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2314.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1067.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":925.99,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1929.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10288.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2057.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2958.03,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2958.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2186.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10931.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9645.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1196.07,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10288.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10931.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6430.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1736.23,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":18648.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5787.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3253.83,"methodology":"percent of total billed charges"}]}]},{"description":"Colonoscopy through stoma; with biopsy, single or multiple ","code_information":[{"code":"361","type":"RC"},{"code":"44389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with endoscopic mucosal resection ","code_information":[{"code":"361","type":"RC"},{"code":"44403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of foreign body(s) ","code_information":[{"code":"44390","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic balloon dilation ","code_information":[{"code":"361","type":"RC"},{"code":"44405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic balloon dilation ","code_information":[{"code":"44405","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"45398","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"45382","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"45393","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with endoscopic mucosal resection ","code_information":[{"code":"369","type":"RC"},{"code":"45390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures ","code_information":[{"code":"360","type":"RC"},{"code":"45391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"360","type":"RC"},{"code":"45379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"360","type":"RC"},{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with transendoscopic balloon dilation ","code_information":[{"code":"45386","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, desc ","code_information":[{"code":"45392","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk ","code_information":[{"code":"360","type":"RC"},{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Colpocentesis (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"57020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Colpocleisis (Le Fort type) ","code_information":[{"code":"499","type":"RC"},{"code":"57120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical) ","code_information":[{"code":"490","type":"RC"},{"code":"57210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) ","code_information":[{"code":"57283","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12947.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix ","code_information":[{"code":"360","type":"RC"},{"code":"57455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage ","code_information":[{"code":"369","type":"RC"},{"code":"57456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix ","code_information":[{"code":"57461","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Colposcopy of the vulva; with biopsy(s) ","code_information":[{"code":"56821","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Colpotomy; with exploration ","code_information":[{"code":"369","type":"RC"},{"code":"57000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC ","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173436.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":35845.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":67820.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":56184.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":30875.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":70136.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 10+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":81965.52,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":68151.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":66991.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":61510.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":37684.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":66827.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":66827.99,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":68304.60,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":72782.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":112823.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":160428.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":67489.66,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":67489.66,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":72121.30,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":70136.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":74106.29,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":68812.98,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":64181.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":68812.98,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":67489.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":71459.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":82707.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":57204.06,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":68812.98,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":62858.01,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":68812.98,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":71459.64,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":72782.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":68151.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":173436.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":63056.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":143104.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":66166.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64181.34,"methodology":"fee schedule"}]}]},{"description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair ","code_information":[{"code":"499","type":"RC"},{"code":"57265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormo ","code_information":[{"code":"80418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.51,"maximum":869.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":596.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":620.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":614.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":869.22,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":695.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":591.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":591.07,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":724.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":637.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":620.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":620.04,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":649.02,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":573.69,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":573.69,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":576.94,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":695.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":689.58,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":608.45,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":550.51,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":608.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":637.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":608.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":582.38,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":579.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":579.48,"methodology":"fee schedule"}]}]},{"description":"COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL OPENING, WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES ","code_information":[{"code":"499","type":"RC"},{"code":"93533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); ","code_information":[{"code":"361","type":"RC"},{"code":"51726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique ","code_information":[{"code":"360","type":"RC"},{"code":"51727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile) ","code_information":[{"code":"490","type":"RC"},{"code":"51729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Complex uroflowmetry (eg, calibrated electronic equipment) ","code_information":[{"code":"361","type":"RC"},{"code":"51741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Complex uroflowmetry (eg, calibrated electronic equipment) ","code_information":[{"code":"490","type":"RC"},{"code":"51741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording a ","code_information":[{"code":"481","type":"RC"},{"code":"93653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":28542.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":28542.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20484.00,"methodology":"case rate"}]}]},{"description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording a ","code_information":[{"code":"360","type":"RC"},{"code":"93654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6000.00,"maximum":28542.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":6000.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":28542.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20484.00,"methodology":"case rate"}]}]},{"description":"Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure) ","code_information":[{"code":"20985","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION ","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":118993.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":45186.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50660.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":51227.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":38458.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":52390.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":60796.01,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":50907.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":49918.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49918.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":50663.34,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54366.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":83684.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":118993.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":50413.02,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":50413.02,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":53872.74,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52390.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":55355.47,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":51401.51,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":47941.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51401.51,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":50413.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":53378.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":61780.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":42429.77,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":51401.51,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":46953.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":51401.51,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":53378.49,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":54366.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":50907.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":88254.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":47101.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":72819.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":49424.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":47941.79,"methodology":"fee schedule"}]}]},{"description":"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser ","code_information":[{"code":"361","type":"RC"},{"code":"57520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Conjunctival flap; total (such as Gunderson thin flap or purse string flap) ","code_information":[{"code":"68362","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement ","code_information":[{"code":"369","type":"RC"},{"code":"68326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Conjunctivoplasty; with conjunctival graft or extensive rearrangement ","code_information":[{"code":"68320","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent ","code_information":[{"code":"490","type":"RC"},{"code":"68750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Construction of artificial vagina; with graft ","code_information":[{"code":"499","type":"RC"},{"code":"57292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; ","code_information":[{"code":"369","type":"RC"},{"code":"67880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate ","code_information":[{"code":"481","type":"RC"},{"code":"67882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis) ","code_information":[{"code":"31611","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"CONTERSNK 4.5/5.5MM ","code_information":[{"code":"920095","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure) ","code_information":[{"code":"49424","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including i ","code_information":[{"code":"481","type":"RC"},{"code":"49465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method ","code_information":[{"code":"30901","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary surgical intervention ","code_information":[{"code":"42972","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention ","code_information":[{"code":"42962","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49446","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Coracoacromial ligament release, with or without acromioplasty ","code_information":[{"code":"23415","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"CORD BIP ST TUBE FLY LD ","code_information":[{"code":"915961","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1994.00,"discounted_cash":1994.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":329.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":149.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":380.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":287.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":358.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":498.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":438.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":259.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":165.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":143.57,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":299.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":440.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":396.81,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1595.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":319.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":458.62,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":418.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":677.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":458.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":338.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1694.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1495.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":185.44,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":259.22,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1595.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1694.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":997.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":269.19,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2891.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":568.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":897.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":504.48,"methodology":"percent of total billed charges"}]}]},{"description":"Cordocentesis (intrauterine), any method ","code_information":[{"code":"59012","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Corneal relaxing incision for correction of surgically induced astigmatism ","code_information":[{"code":"65772","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Corneal wedge resection for correction of surgically induced astigmatism ","code_information":[{"code":"481","type":"RC"},{"code":"65775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score ","code_information":[{"code":"81493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":997.50,"maximum":1575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1081.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1113.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1575.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1312.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1155.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":1176.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1039.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1039.50,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1249.50,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":1102.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":1102.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":1155.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":1102.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":1055.25,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC ","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":96217.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":82092.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":48252.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":94194.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":70713.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":49900.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":57825.99,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":48487.97,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":80923.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":73536.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":73536.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":73536.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":73536.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":74303.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":45523.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":73536.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":47546.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":47546.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":48188.32,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":51783.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":73169.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":87553.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":48017.21,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":48017.21,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":51312.51,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":49900.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":24000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":52724.78,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":48958.73,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":45663.43,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48958.73,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":26200.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":48017.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":50841.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":58844.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":40356.98,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":48958.73,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":44721.91,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":48958.73,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":50841.76,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":51783.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":48487.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":96217.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":44863.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":79386.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":47075.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45663.43,"methodology":"fee schedule"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC ","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":61459.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26831.64,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":27747.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":31400.46,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":26962.53,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":59589.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":54715.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":33522.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":54149.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":26438.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26438.98,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":26167.05,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28794.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":43221.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":61459.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":26700.75,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26700.75,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":28533.16,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27747.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":29318.48,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":27224.30,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":25391.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27224.30,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":26700.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":28271.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32721.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21914.50,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":27224.30,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":24868.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":27224.30,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":28271.39,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":28794.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26962.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":24946.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":26177.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25391.89,"methodology":"fee schedule"}]}]},{"description":"Coronoidectomy (separate procedure) ","code_information":[{"code":"21070","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Correction claw finger, other methods ","code_information":[{"code":"26499","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Correction claw finger, other methods ","code_information":[{"code":"26499","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"CORRECTION OF BUNION ","code_information":[{"code":"28290","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"CORRECTION OF BUNION ","code_information":[{"code":"28293","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Correction of everted punctum, cautery ","code_information":[{"code":"499","type":"RC"},{"code":"68705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery, cryotherapy, laser surgery) ","code_information":[{"code":"360","type":"RC"},{"code":"67825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Correction of trichiasis; incision of lid margin ","code_information":[{"code":"361","type":"RC"},{"code":"67830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method ","code_information":[{"code":"28296","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method ","code_information":[{"code":"28299","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method ","code_information":[{"code":"28298","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method ","code_information":[{"code":"28292","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) ","code_information":[{"code":"28285","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) ","code_information":[{"code":"28285","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique ","code_information":[{"code":"499","type":"RC"},{"code":"51784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming ","code_information":[{"code":"490","type":"RC"},{"code":"62368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and ","code_information":[{"code":"360","type":"RC"},{"code":"62370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming o ","code_information":[{"code":"361","type":"RC"},{"code":"62367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing ","code_information":[{"code":"790","type":"RC"},{"code":"93640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21936.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":6000.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia ","code_information":[{"code":"93624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7350.00,"maximum":41198.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":17846.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":20326.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":14886.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27784.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23153.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":7350.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8300.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":8000.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29274.00,"methodology":"case rate"}]}]},{"description":"EMBO DIALYSIS CIRCUIT ","code_information":[{"code":"792939","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":88946.00,"discounted_cash":88946.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6670.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":16010.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":7382.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":6404.11,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":13341.90,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":71156.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":14231.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":20457.58,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":20457.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":15120.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":75604.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":66709.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":8271.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":71156.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":75604.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":44473.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":12007.71,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":128971.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":40025.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":22503.34,"methodology":"percent of total billed charges"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision ","code_information":[{"code":"34201","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision ","code_information":[{"code":"34201","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision ","code_information":[{"code":"34111","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision ","code_information":[{"code":"34111","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"ENDOCRINE DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":14984.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7584.01,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":7842.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7656.01,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":7621.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":7473.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7473.03,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6380.01,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8138.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":10538.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":14984.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":7547.02,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7547.02,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8064.95,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7842.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":8286.92,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":7695.00,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7177.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7695.00,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":7547.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7990.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9248.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5343.16,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":7695.00,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":7029.09,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":7695.00,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":7990.96,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":8138.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7621.01,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7051.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":7399.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7177.07,"methodology":"fee schedule"}]}]},{"description":"Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and ","code_information":[{"code":"47543","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imagi ","code_information":[{"code":"361","type":"RC"},{"code":"92978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imagi ","code_information":[{"code":"490","type":"RC"},{"code":"92978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed ","code_information":[{"code":"481","type":"RC"},{"code":"58356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9835.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7061.00,"methodology":"case rate"}]}]},{"description":"Endometrial sampling (biopsy) performed in conjunction with colposcopy (List separately in addition to code for primary procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"58110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endomyocardial biopsy ","code_information":[{"code":"361","type":"RC"},{"code":"93505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) ","code_information":[{"code":"43273","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir ºS or J»); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"44385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck ","code_information":[{"code":"361","type":"RC"},{"code":"51715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Endoscopic plantar fasciotomy ","code_information":[{"code":"29893","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"43260","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, incl ","code_information":[{"code":"43274","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi ","code_information":[{"code":"360","type":"RC"},{"code":"43263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) ","code_information":[{"code":"369","type":"RC"},{"code":"43264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy ","code_information":[{"code":"43262","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, ","code_information":[{"code":"43277","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Endoscopy, wrist, surgical, with release of transverse carpal ligament ","code_information":[{"code":"29848","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated ","code_information":[{"code":"360","type":"RC"},{"code":"36473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each thro ","code_information":[{"code":"36474","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated ","code_information":[{"code":"360","type":"RC"},{"code":"36475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; with implant, muscles attached to implant ","code_information":[{"code":"490","type":"RC"},{"code":"65105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and child ","code_information":[{"code":"15116","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedur ","code_information":[{"code":"15111","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15110","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Epididymectomy; unilateral ","code_information":[{"code":"361","type":"RC"},{"code":"54860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"EPIDURAL CATH INSERTION ","code_information":[{"code":"588097","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":13869.00,"discounted_cash":13869.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1040.17,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2496.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1151.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":998.57,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":2080.35,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11095.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2219.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":3189.87,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3189.87,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2357.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11788.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":10401.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1289.82,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11095.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11788.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6934.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1872.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":20110.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6241.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3508.86,"methodology":"percent of total billed charges"}]}]},{"description":"Epikeratoplasty ","code_information":[{"code":"361","type":"RC"},{"code":"65767","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Unlisted musculoskeletal procedure, head ","code_information":[{"code":"21499","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, anterior segment of eye ","code_information":[{"code":"369","type":"RC"},{"code":"66999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, anterior segment of eye ","code_information":[{"code":"499","type":"RC"},{"code":"66999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, biliary tract ","code_information":[{"code":"47999","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, biliary tract ","code_information":[{"code":"47999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, biliary tract ","code_information":[{"code":"47999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, breast ","code_information":[{"code":"19499","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, breast ","code_information":[{"code":"19499","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, casting or strapping ","code_information":[{"code":"29799","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, colon ","code_information":[{"code":"369","type":"RC"},{"code":"45399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, colon ","code_information":[{"code":"45399","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, colon ","code_information":[{"code":"45399","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, endocrine system ","code_information":[{"code":"361","type":"RC"},{"code":"60699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, extraocular muscle ","code_information":[{"code":"369","type":"RC"},{"code":"67399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, female genital system (nonobstetrical) ","code_information":[{"code":"58999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, femur or knee ","code_information":[{"code":"27599","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, foot or toes ","code_information":[{"code":"28899","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, forearm or wrist ","code_information":[{"code":"25999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, hemic or lymphatic system ","code_information":[{"code":"38999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, liver ","code_information":[{"code":"369","type":"RC"},{"code":"47399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, liver ","code_information":[{"code":"47399","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, liver ","code_information":[{"code":"47399","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, lungs and pleura ","code_information":[{"code":"32999","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, male genital system ","code_information":[{"code":"360","type":"RC"},{"code":"55899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, musculoskeletal system, general ","code_information":[{"code":"20999","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, musculoskeletal system, general ","code_information":[{"code":"20999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, musculoskeletal system, general ","code_information":[{"code":"20999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, neck or thorax ","code_information":[{"code":"21899","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, neck or thorax ","code_information":[{"code":"21899","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, neck or thorax ","code_information":[{"code":"21899","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, neck or thorax ","code_information":[{"code":"21899","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, nose ","code_information":[{"code":"30999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, nose ","code_information":[{"code":"30999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, orbit ","code_information":[{"code":"360","type":"RC"},{"code":"67599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, orbit ","code_information":[{"code":"499","type":"RC"},{"code":"67599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pancreas ","code_information":[{"code":"48999","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pancreas ","code_information":[{"code":"48999","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pelvis or hip joint ","code_information":[{"code":"27299","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pelvis or hip joint ","code_information":[{"code":"27299","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, pharynx, adenoids, or tonsils ","code_information":[{"code":"42999","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, posterior segment ","code_information":[{"code":"361","type":"RC"},{"code":"67299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, rectum ","code_information":[{"code":"45999","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, skin, mucous membrane and subcutaneous tissue ","code_information":[{"code":"17999","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, temporal bone, middle fossa approach ","code_information":[{"code":"69979","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, tongue, floor of mouth ","code_information":[{"code":"41599","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, tongue, floor of mouth ","code_information":[{"code":"41599","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, tongue, floor of mouth ","code_information":[{"code":"41599","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, tongue, floor of mouth ","code_information":[{"code":"41599","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, urinary system ","code_information":[{"code":"53899","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, urinary system ","code_information":[{"code":"53899","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular injection ","code_information":[{"code":"36299","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular injection ","code_information":[{"code":"36299","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular injection ","code_information":[{"code":"36299","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Unlisted procedure, vascular injection ","code_information":[{"code":"36299","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"UPPER GI ENDO W/BAND LIG ","code_information":[{"code":"117246","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4183.00,"discounted_cash":4183.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":313.73,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":752.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":347.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":301.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":627.45,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3346.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":669.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":962.09,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":962.09,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":711.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3555.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3137.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":389.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3346.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3555.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":564.71,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6065.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1882.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1058.30,"methodology":"percent of total billed charges"}]}]},{"description":"Urea nitrogen; semiquantitative (eg, reagent strip test) ","code_information":[{"code":"84525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.87,"maximum":7.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.10,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.13,"methodology":"fee schedule"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"481","type":"RC"},{"code":"50951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"490","type":"RC"},{"code":"50951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"50951","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"50951","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"369","type":"RC"},{"code":"50955","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without ","code_information":[{"code":"490","type":"RC"},{"code":"50957","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"360","type":"RC"},{"code":"50961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"499","type":"RC"},{"code":"50961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without di ","code_information":[{"code":"360","type":"RC"},{"code":"50953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy ","code_information":[{"code":"360","type":"RC"},{"code":"50976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy ","code_information":[{"code":"499","type":"RC"},{"code":"50976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"369","type":"RC"},{"code":"50980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"481","type":"RC"},{"code":"50980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"490","type":"RC"},{"code":"50980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"50980","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ure ","code_information":[{"code":"361","type":"RC"},{"code":"50972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring) ","code_information":[{"code":"490","type":"RC"},{"code":"53500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring) ","code_information":[{"code":"53500","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia ","code_information":[{"code":"490","type":"RC"},{"code":"54316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm ","code_information":[{"code":"54308","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 1-stage reconstruction of male anterior urethra ","code_information":[{"code":"361","type":"RC"},{"code":"53410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage ","code_information":[{"code":"481","type":"RC"},{"code":"53420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage ","code_information":[{"code":"490","type":"RC"},{"code":"53420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage ","code_information":[{"code":"53420","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage ","code_information":[{"code":"53420","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage ","code_information":[{"code":"53425","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage ","code_information":[{"code":"53425","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra ","code_information":[{"code":"361","type":"RC"},{"code":"53415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type) ","code_information":[{"code":"360","type":"RC"},{"code":"53400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethroplasty; second stage (formation of urethra), including urinary diversion ","code_information":[{"code":"53405","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; penile ","code_information":[{"code":"369","type":"RC"},{"code":"53505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; penile ","code_information":[{"code":"481","type":"RC"},{"code":"53505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; penile ","code_information":[{"code":"490","type":"RC"},{"code":"53505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; penile ","code_information":[{"code":"53505","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; perineal ","code_information":[{"code":"490","type":"RC"},{"code":"53510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; perineal ","code_information":[{"code":"53510","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; perineal ","code_information":[{"code":"53510","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous ","code_information":[{"code":"360","type":"RC"},{"code":"53515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous ","code_information":[{"code":"499","type":"RC"},{"code":"53515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra ","code_information":[{"code":"361","type":"RC"},{"code":"53000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urethrotomy or urethrostomy, external (separate procedure); perineal urethra, external ","code_information":[{"code":"53010","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Urine pregnancy test, by visual color comparison methods ","code_information":[{"code":"81025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.18,"maximum":12.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":251.97,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.61,"methodology":"fee schedule"}]}]},{"description":"US BRST BX ADD LESION LT ","code_information":[{"code":"791078","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":61391.00,"discounted_cash":61391.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4604.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11050.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5095.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4420.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":9208.65,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":9822.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14119.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":10436.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46043.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":5709.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49112.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52182.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30695.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":8287.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":89016.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27625.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15531.92,"methodology":"percent of total billed charges"}]}]},{"description":"US BRST BX ADD LESION RT ","code_information":[{"code":"791079","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":61377.00,"discounted_cash":61377.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4603.27,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11047.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":5094.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":4419.14,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":9206.55,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49101.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":9820.32,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14116.71,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14116.71,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":10434.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52170.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46032.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":5708.06,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49101.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":52170.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":30688.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":8285.90,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":88996.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27619.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15528.38,"methodology":"percent of total billed charges"}]}]},{"description":"US DVC PLC BRST 1ST RT ","code_information":[{"code":"790742","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":16512.00,"discounted_cash":16512.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1238.40,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2972.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1370.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1188.86,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":2476.80,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":13209.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2641.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":3797.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3797.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2807.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14035.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12384.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1535.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":13209.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14035.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8256.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":2229.12,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":23942.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7430.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":4177.54,"methodology":"percent of total billed charges"}]}]},{"description":"Use of ophthalmic endoscope (List separately in addition to code for primary procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"66990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40171.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":15470.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10926.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19830.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":13232.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":11299.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":11779.84,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10980.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":37520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":34095.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":34095.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":34095.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":34095.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":34449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":21106.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":34095.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10766.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10766.95,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9816.53,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11726.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":31689.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40171.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10873.56,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10873.56,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":11619.78,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11299.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11939.59,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":11086.76,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10340.54,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11086.76,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10873.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":11513.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13325.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8221.20,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":11086.76,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":10127.33,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":11086.76,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":11513.18,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":11726.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10980.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13360.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10159.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11024.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":10660.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10340.54,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MC ","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":76572.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33091.10,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":34221.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":39122.32,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":33252.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":32606.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32606.84,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32601.93,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35512.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":53850.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76572.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":32929.68,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32929.68,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":35189.56,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34221.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":36158.08,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":33575.36,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":31315.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33575.36,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":32929.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":34866.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40355.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":27303.62,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":33575.36,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":30669.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":33575.36,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":34866.72,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":35512.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33252.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":48420.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":30766.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":39952.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":32284.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31315.48,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC ","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75737.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32745.35,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":33863.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":38695.78,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":32905.08,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":32266.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32266.15,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32246.49,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35141.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":53263.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75737.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":32585.61,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32585.61,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":34821.88,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33863.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":35780.28,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":33224.55,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":30988.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33224.55,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":32585.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":34502.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39933.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":27005.94,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":33224.55,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":30349.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":33224.55,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":34502.41,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":35141.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32905.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":30445.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":31946.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30988.28,"methodology":"fee schedule"}]}]},{"description":"Uterine evacuation and curettage for hydatidiform mole ","code_information":[{"code":"481","type":"RC"},{"code":"59870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Uterine evacuation and curettage for hydatidiform mole ","code_information":[{"code":"490","type":"RC"},{"code":"59870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Uterine evacuation and curettage for hydatidiform mole ","code_information":[{"code":"59870","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Uterine evacuation and curettage for hydatidiform mole ","code_information":[{"code":"59870","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Uvulectomy, excision of uvula ","code_information":[{"code":"361","type":"RC"},{"code":"42140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only (with or without episiotomy and/or forceps); ","code_information":[{"code":"481","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only (with or without episiotomy and/or forceps); ","code_information":[{"code":"490","type":"RC"},{"code":"59409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only (with or without episiotomy and/or forceps); ","code_information":[{"code":"59409","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only (with or without episiotomy and/or forceps); ","code_information":[{"code":"59409","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"369","type":"RC"},{"code":"59612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"481","type":"RC"},{"code":"59612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"490","type":"RC"},{"code":"59612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"59612","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C ","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":15982.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":12322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10111.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":13220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":10613.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10457.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8966.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10161.18,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":13979.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":12835.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8454.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":9963.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9963.88,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7472.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10851.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12513.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15982.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10062.53,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10062.53,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10753.10,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10457.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":3400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11049.06,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":10259.84,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9569.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10259.84,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10062.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":10654.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12331.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6384.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10259.84,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":9371.97,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10259.84,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":10654.45,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10851.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10161.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":7837.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9401.56,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":9865.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9569.27,"methodology":"fee schedule"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC ","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":15982.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":12322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9327.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":13220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":10613.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":9646.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8966.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":9373.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":13979.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":12835.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8454.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":9191.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9191.43,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7472.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10010.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12513.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15982.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":9282.43,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9282.43,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":9919.46,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9646.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":10192.47,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":9464.44,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8827.41,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9464.44,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":9282.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9828.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11375.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6384.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":9464.44,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":8645.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":9464.44,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":9828.45,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10010.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9373.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":7837.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8672.70,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":9100.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8827.41,"methodology":"fee schedule"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC ","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":15982.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":12322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6454.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":13220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":10613.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":6674.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8966.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":6485.82,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":13979.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":12835.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8454.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":12701.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":6359.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6359.88,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7472.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6926.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12513.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15982.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":6422.85,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6422.85,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":6863.63,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6674.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":7052.54,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":6548.78,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6108.00,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6548.78,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":6422.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6800.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7871.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6384.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6548.78,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":5982.06,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6548.78,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":6800.66,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":6926.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6485.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":7837.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6000.95,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":6296.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6108.00,"methodology":"fee schedule"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) ","code_information":[{"code":"369","type":"RC"},{"code":"58262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection) ","code_information":[{"code":"27310","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies ","code_information":[{"code":"27331","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies ","code_information":[{"code":"27331","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; with synovial biopsy only ","code_information":[{"code":"27330","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; with synovial biopsy only ","code_information":[{"code":"27330","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; with synovial biopsy only ","code_information":[{"code":"27330","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, knee; with synovial biopsy only ","code_information":[{"code":"27330","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening ","code_information":[{"code":"27612","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign body ","code_information":[{"code":"25040","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral ","code_information":[{"code":"27332","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with synovectomy, ankle; ","code_information":[{"code":"27625","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with synovectomy, ankle; ","code_information":[{"code":"27625","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with synovectomy, ankle; including tenosynovectomy ","code_information":[{"code":"27626","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area ","code_information":[{"code":"27335","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, with synovectomy, knee; anterior OR posterior ","code_information":[{"code":"27334","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, wrist joint; with biopsy ","code_information":[{"code":"25100","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, wrist joint; with synovectomy ","code_information":[{"code":"25105","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy ","code_information":[{"code":"23106","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"ARTHROWAND 3.5MM 90DEG ","code_information":[{"code":"825191","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1160.00,"discounted_cash":1160.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":191.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":87.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":221.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":167.04,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":208.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":290.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":255.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":150.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":96.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":83.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":174.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":256.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":230.84,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":928.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":185.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":266.80,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":394.40,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":266.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":197.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":986.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":870.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":107.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":150.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":928.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":986.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":580.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":156.60,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1682.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":330.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":522.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":293.48,"methodology":"percent of total billed charges"}]}]},{"description":"Artificial insemination; intra-cervical ","code_information":[{"code":"361","type":"RC"},{"code":"58321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Artificial insemination; intra-uterine ","code_information":[{"code":"369","type":"RC"},{"code":"58322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Artificial insemination; intra-uterine ","code_information":[{"code":"481","type":"RC"},{"code":"58322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Artificial insemination; intra-uterine ","code_information":[{"code":"490","type":"RC"},{"code":"58322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Artificial insemination; intra-uterine ","code_information":[{"code":"58322","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Arytenoidectomy or arytenoidopexy, external approach ","code_information":[{"code":"31400","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Arytenoidectomy or arytenoidopexy, external approach ","code_information":[{"code":"31400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"ASP/INJ CYST REN/PEL ","code_information":[{"code":"116080","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4154.00,"discounted_cash":4154.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":311.55,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":747.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":344.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":299.09,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":623.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3323.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":664.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":955.42,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":955.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":706.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3530.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3115.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":386.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3323.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3530.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2077.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":560.79,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6023.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1869.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1050.96,"methodology":"percent of total billed charges"}]}]},{"description":"Aspiration and injection for treatment of bone cyst ","code_information":[{"code":"20615","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Aspiration and injection for treatment of bone cyst ","code_information":[{"code":"20615","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Aspiration and injection for treatment of bone cyst ","code_information":[{"code":"20615","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Aspiration and/or injection of ganglion cyst(s) any location ","code_information":[{"code":"20612","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Aspiration and/or injection of ganglion cyst(s) any location ","code_information":[{"code":"20612","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous ","code_information":[{"code":"369","type":"RC"},{"code":"50390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy) ","code_information":[{"code":"67015","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy) ","code_information":[{"code":"67015","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"ATTACHMENT SURG DISP ","code_information":[{"code":"939252","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3900.00,"discounted_cash":3900.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":643.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":292.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":744.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":561.60,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":702.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":975.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":858.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":507.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":323.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":280.80,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":585.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":861.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":776.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3120.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":624.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":819.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1326.00,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":663.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3315.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2925.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":362.70,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":507.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3120.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3315.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1950.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":526.50,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5655.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1111.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1755.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":986.70,"methodology":"percent of total billed charges"}]}]},{"description":"ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":205.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":205.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":171.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":153.44,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":163.03,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) ","code_information":[{"code":"21127","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) ","code_information":[{"code":"20937","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary pro ","code_information":[{"code":"20938","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary pro ","code_information":[{"code":"20938","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score ","code_information":[{"code":"81490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":798.62,"maximum":1260.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":865.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":891.09,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1260.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1008.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1050.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":941.53,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":832.24,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":832.24,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1008.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1000.37,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":798.62,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":844.85,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"}]}]},{"description":"Autologous chondrocyte implantation, knee ","code_information":[{"code":"27412","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Autologous chondrocyte implantation, knee ","code_information":[{"code":"27412","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure) ","code_information":[{"code":"11732","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Avulsion of nail plate, partial or complete, simple; single ","code_information":[{"code":"11730","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Avulsion of nail plate, partial or complete, simple; single ","code_information":[{"code":"11730","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Axillary lymphadenectomy; complete ","code_information":[{"code":"360","type":"RC"},{"code":"38745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"BACITRACIN 0.9GM OINT ","code_information":[{"code":"791666","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1.00,"discounted_cash":1.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":0.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":0.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":0.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":0.20,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":0.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":0.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":0.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":0.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"}]}]},{"description":"BAG FECAL MGMT REPL ","code_information":[{"code":"872875","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":396.00,"discounted_cash":396.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":65.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":29.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":75.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":57.02,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":71.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":99.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":87.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":51.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":32.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":28.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":59.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":87.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":78.80,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":316.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":63.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":91.08,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":134.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":91.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":67.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":336.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":297.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":36.83,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":51.48,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":316.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":336.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":53.46,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":574.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":112.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":178.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":100.19,"methodology":"percent of total billed charges"}]}]},{"description":"BAG PRESS INFSR 500ML ","code_information":[{"code":"826193","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":112.05,"discounted_cash":112.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":16.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":20.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":28.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":24.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":9.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":8.07,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":16.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":24.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":22.30,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":89.64,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":17.93,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":25.77,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":38.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":25.77,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":19.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":95.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":84.04,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":89.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":95.24,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.02,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":15.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":162.47,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":31.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":50.42,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":28.35,"methodology":"percent of total billed charges"}]}]},{"description":"BAG SPEC RETRVL 224ML ","code_information":[{"code":"807020","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1143.00,"discounted_cash":1143.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":188.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":85.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":218.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":164.59,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":205.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":285.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":251.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":148.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":94.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":82.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":171.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":252.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":227.46,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":914.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":182.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":262.89,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":240.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":388.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":262.89,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":194.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":971.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":857.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":106.30,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":148.59,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":914.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":971.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":154.31,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1657.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":325.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":514.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":289.18,"methodology":"percent of total billed charges"}]}]},{"description":"BALLN LUTNX OTW5X100X130 ","code_information":[{"code":"875719","type":"CDM"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":9236.00,"discounted_cash":9236.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":1523.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1764.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":1329.98,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1662.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2309.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2031.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1200.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1385.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":2041.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1837.96,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7388.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1477.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2124.28,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1939.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":3140.24,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2124.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1570.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7850.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6927.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":858.95,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1200.68,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7388.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7850.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4618.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1246.86,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":13392.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2632.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4156.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2336.71,"methodology":"percent of total billed charges"}]}]},{"description":"Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each d ","code_information":[{"code":"47542","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each d ","code_information":[{"code":"47542","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each d ","code_information":[{"code":"47542","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"BASIC OR SERVICES ","code_information":[{"code":"797590","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1.00,"discounted_cash":1.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":0.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":0.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":0.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"}]}]},{"description":"BASKET RTRV 3WR 1.9X120 ","code_information":[{"code":"800991","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BEDSIDE PROCEDURE LVL 1 ","code_information":[{"code":"344748","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2534.00,"discounted_cash":2534.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":190.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":456.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":210.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":182.45,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":380.10,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2027.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":405.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":582.82,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":582.82,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":430.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2153.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1900.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":235.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2027.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2153.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1267.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":342.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3674.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1140.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":641.10,"methodology":"percent of total billed charges"}]}]},{"description":"BEDSIDE PROCEDURE LVL 5 ","code_information":[{"code":"796423","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":46609.00,"discounted_cash":46609.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3495.68,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8389.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":3868.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":3355.85,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":6991.35,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":37287.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":7457.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":10720.07,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":10720.07,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":7923.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":39617.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":34956.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4334.64,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":37287.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":39617.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23304.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":6292.22,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":67583.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20974.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":11792.08,"methodology":"percent of total billed charges"}]}]},{"description":"BENZOCAINE 10% LIQ ","code_information":[{"code":"15577","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":158.00,"discounted_cash":158.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":26.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":30.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":22.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":39.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":34.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":13.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":11.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":23.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":34.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":31.44,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":126.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":25.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":36.34,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":53.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":36.34,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":26.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":134.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":118.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":126.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":134.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":21.33,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":229.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":45.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":71.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":39.97,"methodology":"percent of total billed charges"}]}]},{"description":"BENZOCAINE 20% SPR 60ML ","code_information":[{"code":"11575","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":995.00,"discounted_cash":995.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":164.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":74.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":190.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":143.28,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":179.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":248.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":218.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":129.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":82.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":71.64,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":149.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":219.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":198.00,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":796.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":159.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":228.85,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":208.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":338.30,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":228.85,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":169.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":845.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":746.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":92.53,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":129.35,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":796.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":845.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":497.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":134.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1442.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":283.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":447.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":251.74,"methodology":"percent of total billed charges"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure) ","code_information":[{"code":"47552","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure) ","code_information":[{"code":"47552","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent ","code_information":[{"code":"360","type":"RC"},{"code":"47556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without stent ","code_information":[{"code":"47555","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without stent ","code_information":[{"code":"47555","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Bilirubin, total, transcutaneous ","code_information":[{"code":"88720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.77,"maximum":7.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"}]}]},{"description":"Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance ","code_information":[{"code":"369","type":"RC"},{"code":"55706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance ","code_information":[{"code":"481","type":"RC"},{"code":"55706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of anorectal wall, anal approach (eg, congenital megacolon) ","code_information":[{"code":"45100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of anorectal wall, anal approach (eg, congenital megacolon) ","code_information":[{"code":"45100","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of conjunctiva ","code_information":[{"code":"360","type":"RC"},{"code":"68100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of extraocular muscle ","code_information":[{"code":"361","type":"RC"},{"code":"67346","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biopsy of floor of mouth ","code_information":[{"code":"41108","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of lacrimal gland ","code_information":[{"code":"361","type":"RC"},{"code":"68510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of lacrimal sac ","code_information":[{"code":"361","type":"RC"},{"code":"68525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of lip ","code_information":[{"code":"361","type":"RC"},{"code":"40490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy of lip ","code_information":[{"code":"40490","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy of liver, needle; percutaneous ","code_information":[{"code":"47000","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"47001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) ","code_information":[{"code":"11755","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) ","code_information":[{"code":"11755","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of nerve ","code_information":[{"code":"361","type":"RC"},{"code":"64795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of ovary, unilateral or bilateral (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"58900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of palate, uvula ","code_information":[{"code":"42100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of pancreas, percutaneous needle ","code_information":[{"code":"48102","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of salivary gland; needle ","code_information":[{"code":"361","type":"RC"},{"code":"42400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED; EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCED ","code_information":[{"code":"11101","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED; SINGLE LESION ","code_information":[{"code":"11100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Biopsy of spinal cord, percutaneous needle ","code_information":[{"code":"361","type":"RC"},{"code":"62269","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of stomach, by laparotomy ","code_information":[{"code":"360","type":"RC"},{"code":"43605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, incisional (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"54505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of urethra ","code_information":[{"code":"369","type":"RC"},{"code":"53200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of urethra ","code_information":[{"code":"481","type":"RC"},{"code":"53200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of urethra ","code_information":[{"code":"490","type":"RC"},{"code":"53200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) ","code_information":[{"code":"369","type":"RC"},{"code":"57105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) ","code_information":[{"code":"481","type":"RC"},{"code":"57105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; simple (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"57100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; simple (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"57100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; simple (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"57100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); 1 lesion ","code_information":[{"code":"499","type":"RC"},{"code":"56605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"56606","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) ","code_information":[{"code":"369","type":"RC"},{"code":"38505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) ","code_information":[{"code":"38505","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"369","type":"RC"},{"code":"38520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"38520","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"38520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"38520","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, internal mammary node(s) ","code_information":[{"code":"360","type":"RC"},{"code":"38530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, internal mammary node(s) ","code_information":[{"code":"38530","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, superficial ","code_information":[{"code":"369","type":"RC"},{"code":"38500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy thyroid, percutaneous core needle ","code_information":[{"code":"361","type":"RC"},{"code":"60100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy thyroid, percutaneous core needle ","code_information":[{"code":"499","type":"RC"},{"code":"60100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) ","code_information":[{"code":"20225","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) ","code_information":[{"code":"20220","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) ","code_information":[{"code":"20220","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19084","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19084","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19086","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including s ","code_information":[{"code":"19081","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including u ","code_information":[{"code":"19083","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, pleura, percutaneous needle ","code_information":[{"code":"32400","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, pleura, percutaneous needle ","code_information":[{"code":"32400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"369","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"481","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"490","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"55705","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; needle or punch, single or multiple, any approach ","code_information":[{"code":"360","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; superficial ","code_information":[{"code":"21920","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; superficial ","code_information":[{"code":"21920","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular) ","code_information":[{"code":"27614","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular) ","code_information":[{"code":"27614","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular ","code_information":[{"code":"27041","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; superficial ","code_information":[{"code":"27040","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; deep ","code_information":[{"code":"23066","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; superficial ","code_information":[{"code":"23065","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) ","code_information":[{"code":"27324","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"NEEDLE INTSTM 5IN 20GA ","code_information":[{"code":"919589","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1239.00,"discounted_cash":1239.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":204.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":92.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":236.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":178.42,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":223.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":309.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":272.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":161.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":102.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":89.21,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":185.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":273.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":246.56,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":991.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":198.24,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":284.97,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":260.19,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":421.26,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":284.97,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":210.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1053.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":929.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":115.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":161.07,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":991.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1053.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":167.26,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1796.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":353.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":557.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":313.47,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE KOPANS BRST 20G 7 ","code_information":[{"code":"916923","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1358.00,"discounted_cash":1358.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":224.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":101.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":259.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":195.55,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":244.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":339.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":298.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":176.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":112.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":97.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":203.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":300.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":270.24,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1086.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":217.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":312.34,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":285.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":461.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":312.34,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":230.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1154.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1018.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":126.29,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":176.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1086.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1154.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":679.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":183.33,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1969.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":387.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":343.57,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE NORIAN DELIVERY K ","code_information":[{"code":"860956","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1906.00,"discounted_cash":1906.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":314.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":142.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":364.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":274.46,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":343.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":476.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":419.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":247.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":158.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":137.23,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":285.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":421.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":379.29,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1524.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":304.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":438.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":400.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":648.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":438.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":324.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1620.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1429.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":177.26,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":247.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1524.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1620.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":953.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":257.31,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2763.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":543.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":857.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":482.22,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE PASSER SUTURE ","code_information":[{"code":"824471","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE PORT DIL 1.5MM ","code_information":[{"code":"926078","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2013.00,"discounted_cash":2013.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":332.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":150.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":384.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":289.87,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":362.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":503.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":442.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":261.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":167.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":144.94,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":301.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":444.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":400.59,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1610.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":322.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":462.99,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":684.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":462.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":342.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1711.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1509.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":187.21,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":261.69,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1610.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1711.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":271.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2918.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":573.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":905.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":509.29,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE SUT C-13 RVRS CUT ","code_information":[{"code":"921987","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":588.00,"discounted_cash":588.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":97.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":44.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":112.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":84.67,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":105.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":147.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":129.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":76.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":48.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":42.34,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":88.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":129.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":117.01,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":470.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":94.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":135.24,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":199.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":135.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":99.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":499.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":441.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":54.68,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":76.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":470.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":499.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":294.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":79.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":852.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":167.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":264.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":148.76,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE SUT MO-6 ","code_information":[{"code":"942326","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1765.00,"discounted_cash":1765.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":291.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":132.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":337.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":254.16,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":317.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":441.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":388.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":229.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":127.08,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":264.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":390.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":351.24,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1412.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":282.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":405.95,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":370.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":600.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":405.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":300.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1500.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1323.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":164.15,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":229.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1412.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1500.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":882.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":238.28,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2559.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":503.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":794.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":446.55,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE TARGET 11GA 15CM ","code_information":[{"code":"921209","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":774.00,"discounted_cash":774.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":127.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":58.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":147.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":111.46,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":139.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":193.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":170.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":100.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":64.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":55.73,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":116.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":171.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":154.03,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":619.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":123.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":178.02,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":263.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":178.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":131.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":657.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":71.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":100.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":619.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":657.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":104.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1122.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":220.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":348.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":195.82,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE TIP 3CM ","code_information":[{"code":"816258","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLE TRNSPTL 18GA 71CM ","code_information":[{"code":"929263","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"NEEDLES REPAIR SUT 2-0 ","code_information":[{"code":"864872","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"NEPH CATH CONV TO NEPURT ","code_information":[{"code":"792301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":20426.00,"discounted_cash":20426.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1531.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3676.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1695.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1470.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":3063.90,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16340.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":3268.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":4697.98,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4697.98,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":3472.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":17362.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":15319.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1899.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16340.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":17362.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10213.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":2757.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":29617.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9191.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":5167.78,"methodology":"percent of total billed charges"}]}]},{"description":"NEPH CATH EXCHANGE ","code_information":[{"code":"791973","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":15825.00,"discounted_cash":15825.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1186.88,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2848.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1313.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":1139.40,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":2373.75,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12660.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2532.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":3639.75,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3639.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2690.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13451.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":11868.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1471.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12660.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13451.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7912.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":2136.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":22946.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7121.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":4003.72,"methodology":"percent of total billed charges"}]}]},{"description":"Nephrology (diabetic chronic kidney disease), multiplex electrochiluminescent immunoassay of soluble tumor necrosis factor receptor 1, 2, and kidney injury molecule 1 combined with clinical data, plas ","code_information":[{"code":"0407U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":756.66,"maximum":1140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":978.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":1064.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":940.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":940.50,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":756.66,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1130.50,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":902.50,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":954.75,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"}]}]},{"description":"Nephrostomy, nephrotomy with drainage ","code_information":[{"code":"361","type":"RC"},{"code":"50040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length ","code_information":[{"code":"490","type":"RC"},{"code":"64885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length ","code_information":[{"code":"64885","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length ","code_information":[{"code":"481","type":"RC"},{"code":"64898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more than 4 cm length ","code_information":[{"code":"64898","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length ","code_information":[{"code":"369","type":"RC"},{"code":"64896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more than 4 cm length ","code_information":[{"code":"499","type":"RC"},{"code":"64896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length ","code_information":[{"code":"360","type":"RC"},{"code":"64893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length ","code_information":[{"code":"360","type":"RC"},{"code":"64891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"64902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"64901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Nerve pedicle transfer; first stage ","code_information":[{"code":"64905","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve ","code_information":[{"code":"360","type":"RC"},{"code":"64911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Neurectomy, popliteal (gastrocnemius) ","code_information":[{"code":"27326","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Neurectomy, popliteal (gastrocnemius) ","code_information":[{"code":"27326","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Neurectomy, popliteal (gastrocnemius) ","code_information":[{"code":"27326","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Neuro Inh Ataxia Genomic DNA Seq Alys 51 Bld/Slv ","code_information":[{"code":"0217U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2088.43,"maximum":3297.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2264.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2352.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2330.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3297.52,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":2638.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":2242.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2242.32,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2747.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2418.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2352.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2352.23,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2462.15,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2176.37,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2176.37,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2638.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2616.04,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":2308.27,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":2088.43,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":2308.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2418.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":2308.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":2209.34,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":2198.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2198.35,"methodology":"fee schedule"}]}]},{"description":"Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking-induced conformational conversion, qualitative ","code_information":[{"code":"0035U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":513.94,"maximum":811.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":557.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":573.45,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":811.49,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":649.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":676.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":595.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":605.91,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":535.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":535.58,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":649.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":643.78,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":568.04,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":513.94,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":568.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":595.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":568.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":543.69,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":540.99,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty and/or transposition; median nerve at carpal tunnel ","code_information":[{"code":"369","type":"RC"},{"code":"64721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty and/or transposition; median nerve at carpal tunnel ","code_information":[{"code":"490","type":"RC"},{"code":"64721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty and/or transposition; median nerve at carpal tunnel ","code_information":[{"code":"64721","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty and/or transposition; ulnar nerve at wrist ","code_information":[{"code":"64719","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus ","code_information":[{"code":"64713","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus ","code_information":[{"code":"64714","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified ","code_information":[{"code":"360","type":"RC"},{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified ","code_information":[{"code":"481","type":"RC"},{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified ","code_information":[{"code":"490","type":"RC"},{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified ","code_information":[{"code":"64708","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty; digital, 1 or both, same digit ","code_information":[{"code":"64702","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Neuroplasty; nerve of hand or foot ","code_information":[{"code":"360","type":"RC"},{"code":"64704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nickel ","code_information":[{"code":"83885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.28,"maximum":36.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct ","code_information":[{"code":"19110","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct ","code_information":[{"code":"19110","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Nocturnal penile tumescence and/or rigidity test ","code_information":[{"code":"360","type":"RC"},{"code":"54250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Nocturnal penile tumescence and/or rigidity test ","code_information":[{"code":"481","type":"RC"},{"code":"54250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Nocturnal penile tumescence and/or rigidity test ","code_information":[{"code":"490","type":"RC"},{"code":"54250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Nocturnal penile tumescence and/or rigidity test ","code_information":[{"code":"54250","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC ","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":41724.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18658.57,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19295.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":21317.91,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":18749.58,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18385.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18385.51,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17764.93,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20023.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29343.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":41724.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":18567.55,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18567.55,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":19841.79,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19295.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20387.90,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":18931.62,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17657.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18931.62,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":18567.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":19659.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22754.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14877.86,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18931.62,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17293.31,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18931.62,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":19659.76,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":20023.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18749.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17347.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":18203.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17657.38,"methodology":"fee schedule"}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC ","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":18412.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9003.69,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":9311.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9407.36,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":9047.61,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8871.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8871.92,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7839.47,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9662.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12949.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18412.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8959.76,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8959.76,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":9574.65,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9311.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":9135.45,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8520.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9135.45,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8959.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9486.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10980.10,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6565.43,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":9135.45,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":8344.88,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":9135.45,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":9486.81,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9662.49,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9047.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8371.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8784.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8520.56,"methodology":"fee schedule"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC ","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":66991.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":26324.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8401.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":35944.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":19297.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":8688.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8664.36,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":8442.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":66991.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":61510.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":37684.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":60875.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8278.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8278.45,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7220.30,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9016.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":22439.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26874.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8360.42,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8360.42,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8934.17,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8688.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9180.07,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8524.35,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7950.59,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8524.35,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8360.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8852.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10245.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6046.89,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8524.35,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":7786.66,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8524.35,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8852.21,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9016.14,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8442.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7811.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8196.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7950.59,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC ","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":17404.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8586.23,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":8879.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8892.37,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":8628.11,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8460.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8460.58,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7410.31,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9214.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12240.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":17404.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8544.35,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8544.35,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":9130.72,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8879.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9382.03,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8711.88,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8125.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8711.88,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8544.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9046.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10471.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6206.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8711.88,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":7957.97,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8711.88,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":9046.95,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9214.49,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8628.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7983.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8376.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8125.50,"methodology":"fee schedule"}]}]},{"description":"NRAS (neuroblastoma RAS viral ºv-ras» oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) ","code_information":[{"code":"81311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281.00,"maximum":443.69,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":304.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":316.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":313.54,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":443.69,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":354.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":301.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":301.71,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":369.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":325.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":316.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":316.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":331.28,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":292.83,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":292.83,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":354.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":351.99,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":310.58,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":281.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":310.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":325.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":310.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":295.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":295.79,"methodology":"fee schedule"}]}]},{"description":"NUT CON EXFX RNG M6 6MM ","code_information":[{"code":"872442","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":624.00,"discounted_cash":624.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":102.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":46.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":119.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":89.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":112.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":156.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":137.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":81.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":51.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":44.93,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":93.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":137.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":124.18,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":499.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":99.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":143.52,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":131.04,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":212.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":143.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":106.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":530.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":468.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":58.03,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":81.12,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":499.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":530.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":312.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":84.24,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":904.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":177.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":280.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":157.87,"methodology":"percent of total billed charges"}]}]},{"description":"NUT THRD COUPLING 40MM E ","code_information":[{"code":"910535","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH CC ","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52878.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":38831.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14100.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":52878.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":35285.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":14581.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15694.33,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":14168.78,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":33839.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":31073.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":19037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13893.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13893.66,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13078.61,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15131.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35361.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":44978.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":14031.22,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14031.22,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":14994.15,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14581.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":15000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15406.83,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":14306.34,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13343.42,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14306.34,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":6700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":14031.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14856.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17195.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10953.14,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14306.34,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":13068.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":14306.34,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":14856.59,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":15131.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14168.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13109.56,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13756.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13343.42,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC ","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52878.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":38831.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13022.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":52878.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":35285.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":13467.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14365.59,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":13086.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":33839.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":31073.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":19037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":30751.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":12832.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12832.32,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11971.32,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13975.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35361.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":44978.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12959.38,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12959.38,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":13848.74,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13467.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":15000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":14229.90,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":13213.48,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12324.11,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13213.48,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":6700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":12959.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":13721.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15881.59,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10025.80,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13213.48,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":12070.01,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":13213.48,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":13721.69,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":13975.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13086.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12108.12,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12705.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12324.11,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC ","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40612.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18198.10,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":18819.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20749.86,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":18286.87,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":17931.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17931.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17291.55,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19529.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":28561.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40612.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":18109.32,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18109.32,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":19352.12,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18819.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":19884.75,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":18464.41,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17221.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18464.41,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":18109.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":19174.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22192.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14481.41,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18464.41,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":16866.53,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18464.41,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":19174.58,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19529.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18286.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":16919.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17754.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17221.61,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS ","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":39856.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32682.41,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":33798.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1857.18,"methodology":"fee schedule","additional_payer_notes":"Days 1. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":38618.14,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":32841.84,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":32204.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32204.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32181.79,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35073.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":32522.99,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32522.99,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":34754.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33798.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":35711.51,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":33160.69,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":30928.72,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33160.69,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":32522.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":34436.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39856.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":26951.75,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":33160.69,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":30291.02,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":33160.69,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":34436.10,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":35073.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32841.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":30386.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":31885.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30928.72,"methodology":"fee schedule"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"361","type":"RC"},{"code":"58615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"481","type":"RC"},{"code":"58615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"490","type":"RC"},{"code":"58615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"58615","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"OCTREOTID ND SQIV 100MCG ","drug_information":{"unit":"100","type":"GM"},"code_information":[{"code":"6759","type":"CDM"},{"code":"J2354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":293.00,"discounted_cash":293.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":52.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":73.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":64.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":38.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":43.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":64.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":58.31,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":234.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":46.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":67.39,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":61.53,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":99.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":67.39,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":49.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":249.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":219.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":27.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":38.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":234.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":249.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":39.55,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":424.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":83.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":131.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":74.13,"methodology":"percent of total billed charges"}]}]},{"description":"OCTREOTID ND SQIV 50MCG ","drug_information":{"unit":"50","type":"GM"},"code_information":[{"code":"6773","type":"CDM"},{"code":"J2354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":52.00,"discounted_cash":52.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.35,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":41.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":8.32,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":11.96,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":17.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":11.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":44.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":39.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.84,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":41.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":44.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":75.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":13.16,"methodology":"percent of total billed charges"}]}]},{"description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) ","code_information":[{"code":"481","type":"RC"},{"code":"65782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) ","code_information":[{"code":"490","type":"RC"},{"code":"65782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) ","code_information":[{"code":"65782","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Ocular surface reconstruction; limbal stem cell allograft (eg, cadaveric or living donor) ","code_information":[{"code":"65781","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage ","code_information":[{"code":"81518","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes (8 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk score ","code_information":[{"code":"81522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LCMS/MS) using multiple r ","code_information":[{"code":"0002U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.75,"maximum":37.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":26.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":37.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":30.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":31.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29.75,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":27.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (cutaneous melanoma), mRNA gene expression profiling by RT-PCR of 35 genes (32 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a c ","code_information":[{"code":"0314U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1852.50,"maximum":2925.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2008.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":2067.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2925.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":2340.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2145.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":2184.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1930.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1930.50,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2340.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2320.50,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":2047.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":1852.50,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":2047.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":2145.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":2047.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":1959.75,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (gastrointestinal neuroendocrine tumors), real-time PCR expression analysis of 51 genes, utilizing whole peripheral blood, algorithm reported as a nomogram of tumor disease index ","code_information":[{"code":"0007M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":356.25,"maximum":562.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":386.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":397.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":562.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":450.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":382.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":382.50,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":468.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":412.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":420.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":371.25,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":371.25,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":450.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":446.25,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":356.25,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":412.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":376.87,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":375.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (hepatic), mRNA expression levels of 161 genes, utilizing fresh hepatocellular carcinoma tumor tissue, with alpha-fetoprotein level, algorithm reported as a risk classifier ","code_information":[{"code":"0006M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142.50,"maximum":225.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":154.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":159.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":225.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":180.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":187.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":168.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":148.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":148.50,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":180.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":178.50,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":157.50,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":142.50,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":157.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":157.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":150.75,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (lung), mRNA, quantitative PCR analysis of 11 genes (BAG1,BRCA1,CDC6, CDK2AP1, ERBB3, FUT3, IL11, LCK, RND3, SH3BGR, WNT3A) and 3 reference genes (ESD, TBP, YAP1), formalin-fixed paraffin emb ","code_information":[{"code":"0288U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (Merkel cell-carcinoma), detection of antibodies to the Merkel cell polyoma virus capsid protein (VP1), serum, reported as positive or negative ","code_information":[{"code":"0059U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306.81,"maximum":484.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":332.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":342.34,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":484.44,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":387.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":403.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":361.72,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":319.73,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":319.73,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":387.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":384.32,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":324.57,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"}]}]},{"description":"Oncology (pan-tumor), genetic profiling of 8 DNA-regulatory markers by qPCR, whole blood, reported as a high or low probability of responding to immune checkpoint-inhibitor therapy ","code_information":[{"code":"0332U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1084.96,"maximum":1713.09,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1176.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1210.58,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1713.09,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1370.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":1164.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1164.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1256.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":1279.11,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1130.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1130.64,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1370.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1359.05,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":1199.16,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":1084.96,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":1199.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":1256.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":1199.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":1147.77,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease ","code_information":[{"code":"81541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":5809.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3989.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5809.50,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4841.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4337.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4608.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (Prostate), mRNA, gene expression peofiling of 18 genes, first-catch, algorithm reported as percentage of likelihood of detecting clinical significant prostate cancer ","code_information":[{"code":"0403U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":1140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":782.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":851.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":904.40,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (thyroid), mutation analysis of 10 genes and 37 RNA fusions and expression of 4 mRNA markers using next-generation sequencing, fine needle aspirate, report includes associated risk of maligna ","code_information":[{"code":"0245U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1202.77,"maximum":1899.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1304.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1342.03,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1899.11,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":1519.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":1291.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1291.39,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1582.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1392.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":1418.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1253.41,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1253.41,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1519.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1506.62,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":1329.37,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":1202.77,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":1329.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":1392.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":1329.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":1272.40,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"}]}]},{"description":"Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores ","code_information":[{"code":"81504","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":494.00,"maximum":780.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":535.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":556.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":551.20,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":780.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":624.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":530.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":530.40,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":650.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":572.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":556.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":556.40,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":582.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":514.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":514.80,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":624.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":618.80,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":546.00,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":494.00,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":546.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":572.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":546.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":522.60,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":520.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":520.00,"methodology":"fee schedule"}]}]},{"description":"OP VISIT LEVEL 2 NP ","code_information":[{"code":"122851","type":"CDM"},{"code":"99202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1037.00,"discounted_cash":1037.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":171.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":198.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":149.33,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":186.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":518.50,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":518.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":518.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":829.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":238.51,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":881.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":777.75,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":134.81,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":518.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":829.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":881.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":518.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":295.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":466.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":262.36,"methodology":"percent of total billed charges"}]}]},{"description":"OP VISIT LEVEL 4 NP ","code_information":[{"code":"122854","type":"CDM"},{"code":"99204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2681.00,"discounted_cash":2681.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":442.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":512.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":386.06,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":482.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1340.50,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1340.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1340.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2144.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":616.63,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2278.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2010.75,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":348.53,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1340.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2144.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2278.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1340.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":764.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1206.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":678.29,"methodology":"percent of total billed charges"}]}]},{"description":"Open osteochondral autograft, talus (includes obtaining graftºs») ","code_information":[{"code":"28446","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting ","code_information":[{"code":"22319","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting ","code_information":[{"code":"22319","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting ","code_information":[{"code":"22318","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting ","code_information":[{"code":"22318","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical ","code_information":[{"code":"22326","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to co ","code_information":[{"code":"22103","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to co ","code_information":[{"code":"22103","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar ","code_information":[{"code":"22102","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar ","code_information":[{"code":"22102","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar ","code_information":[{"code":"22102","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic ","code_information":[{"code":"22101","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic ","code_information":[{"code":"22101","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic ","code_information":[{"code":"22101","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Partial hymenectomy or revision of hymenal ring ","code_information":[{"code":"56700","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy ","code_information":[{"code":"499","type":"RC"},{"code":"60212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"PASSER CNCPT ARTHSCP NDL ","code_information":[{"code":"860457","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PASSER EX3 PLATES AND NE ","code_information":[{"code":"900675","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1641.00,"discounted_cash":1641.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":270.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":123.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":313.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":236.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":295.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":410.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":361.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":213.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":136.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":118.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":246.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":362.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":326.56,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1312.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":262.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":377.43,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":344.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":557.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":377.43,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":278.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1394.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1230.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":152.61,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":213.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1312.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1394.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":820.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":221.53,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2379.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":467.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":738.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":415.17,"methodology":"percent of total billed charges"}]}]},{"description":"PASSER HIP XL ","code_information":[{"code":"905363","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5570.00,"discounted_cash":5570.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":919.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":417.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1063.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":802.08,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1002.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1392.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1225.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":724.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":462.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":401.04,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":835.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1230.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1108.43,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4456.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":891.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1281.10,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1169.70,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1893.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1281.10,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":946.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4734.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4177.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":518.01,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":724.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4456.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4734.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2785.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":751.95,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8076.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1587.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2506.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1409.21,"methodology":"percent of total billed charges"}]}]},{"description":"PASSER SUT 90D CRV STR ","code_information":[{"code":"874040","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PASSER SUTURE 45D CRV LT ","code_information":[{"code":"830366","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PASSER SUTURE STR ","code_information":[{"code":"847253","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"Patellectomy or hemipatellectomy ","code_information":[{"code":"27350","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"PATH CONS PREP SLIDES ","code_information":[{"code":"155989","type":"CDM"},{"code":"88323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":9206.00,"discounted_cash":9206.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1657.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2301.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2025.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1196.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":1380.90,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7364.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1472.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2117.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1933.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":3130.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2117.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1565.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7825.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6904.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":856.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1196.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7364.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7825.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4603.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1242.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":13348.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2623.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4142.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2329.12,"methodology":"percent of total billed charges"}]}]},{"description":"PATH ESTERASE STAIN ","code_information":[{"code":"155983","type":"CDM"},{"code":"88319","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1981.00,"discounted_cash":1981.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":356.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":495.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":435.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":257.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":297.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1584.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":316.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":455.63,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":416.01,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":673.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":455.63,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":336.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1683.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1485.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":184.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":257.53,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1584.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1683.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":990.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":267.44,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2872.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":564.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":891.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":501.19,"methodology":"percent of total billed charges"}]}]},{"description":"PATH GIEMSA STAIN ","code_information":[{"code":"155914","type":"CDM"},{"code":"88312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":656.00,"discounted_cash":656.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":118.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":164.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":144.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":85.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":98.40,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":524.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":104.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":150.88,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":137.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":223.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":150.88,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":111.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":557.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":492.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":61.01,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":85.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":524.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":557.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":328.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":88.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":951.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":186.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":295.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":165.97,"methodology":"percent of total billed charges"}]}]},{"description":"Peanut allergen-specific quantitative assessment of multiple epitopes using enzyme-linked immunosorbent assay (ELISA), blood, report of minimum eliciting exposure for a clinical reaction ","code_information":[{"code":"0178U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.87,"maximum":689.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":473.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":487.45,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":689.79,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":551.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":469.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":469.06,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":574.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":505.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":515.04,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":455.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":455.26,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":551.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":547.23,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":482.85,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":436.87,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":482.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":505.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":482.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":462.16,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":459.86,"methodology":"fee schedule"}]}]},{"description":"Pelvic examination under anesthesia (other than local) ","code_information":[{"code":"57410","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Penile plethysmography ","code_information":[{"code":"54240","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"PENIS PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":28879.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13338.39,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":13793.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14754.78,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":13403.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":14707.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13143.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13143.19,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12295.65,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14314.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":20309.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28879.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":13273.32,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13273.32,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":14184.24,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13793.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":14574.63,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":13533.58,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12622.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13533.58,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":13273.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14054.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16266.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10297.42,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13533.58,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":12362.41,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":13533.58,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":14054.10,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14314.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13403.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12520.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12401.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13013.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12622.67,"methodology":"fee schedule"}]}]},{"description":"PERC MECH THRMB DX ANGIO ","code_information":[{"code":"792720","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":37430.00,"discounted_cash":37430.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2807.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6737.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":3106.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2694.96,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":5614.50,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":29944.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":5988.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":8608.90,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8608.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":6363.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":31815.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28072.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":3480.99,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":29944.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":31815.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18715.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":5053.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":54273.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":16843.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":9469.79,"methodology":"percent of total billed charges"}]}]},{"description":"PERC MECH THRMB STNT PLC ","code_information":[{"code":"792722","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":121292.00,"discounted_cash":121292.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9096.90,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":21832.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":10067.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":8733.02,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":18193.80,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":97033.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":19406.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":27897.16,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27897.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":20619.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":103098.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":90969.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":11280.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":97033.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":103098.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60646.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":16374.42,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":175873.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":54581.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":30686.88,"methodology":"percent of total billed charges"}]}]},{"description":"Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes ","code_information":[{"code":"360","type":"RC"},{"code":"62267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Percutaneous aspiration, spinal cord cyst or syrinx ","code_information":[{"code":"369","type":"RC"},{"code":"62268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Percutaneous implantation of neurostimulator electrode array, epidural ","code_information":[{"code":"63650","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Percutaneous implantation of neurostimulator electrode array; cranial nerve ","code_information":[{"code":"499","type":"RC"},{"code":"64553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) ","code_information":[{"code":"64555","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed ","code_information":[{"code":"361","type":"RC"},{"code":"64561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":66610.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66610.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":47811.00,"methodology":"case rate"}]}]},{"description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) ","code_information":[{"code":"22527","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) ","code_information":[{"code":"22527","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) ","code_information":[{"code":"22527","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) ","code_information":[{"code":"22527","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level ","code_information":[{"code":"22526","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administe ","code_information":[{"code":"62264","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Percutaneous portal vein catheterization by any method ","code_information":[{"code":"36481","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Percutaneous portal vein catheterization by any method ","code_information":[{"code":"36481","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when ","code_information":[{"code":"0201T","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when ","code_information":[{"code":"0201T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, w ","code_information":[{"code":"0200T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, w ","code_information":[{"code":"0200T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of calcaneal fracture, with manipulation ","code_information":[{"code":"28406","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint ","code_information":[{"code":"26676","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation ","code_information":[{"code":"26650","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation ","code_information":[{"code":"26650","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation ","code_information":[{"code":"25606","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation ","code_information":[{"code":"25606","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation ","code_information":[{"code":"25606","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation ","code_information":[{"code":"25606","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of distal radioulnar dislocation ","code_information":[{"code":"25671","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal sepa ","code_information":[{"code":"27509","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal sepa ","code_information":[{"code":"27509","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal sepa ","code_information":[{"code":"27509","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck ","code_information":[{"code":"27235","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck ","code_information":[{"code":"27235","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck ","code_information":[{"code":"27235","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation ","code_information":[{"code":"28496","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation ","code_information":[{"code":"28496","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulation ","code_information":[{"code":"24582","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation ","code_information":[{"code":"28666","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of metacarpal fracture, each bone ","code_information":[{"code":"26608","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of metacarpal fracture, each bone ","code_information":[{"code":"26608","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation ","code_information":[{"code":"26706","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each ","code_information":[{"code":"28476","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation ","code_information":[{"code":"28636","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or ","code_information":[{"code":"27216","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or ","code_information":[{"code":"27216","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension ","code_information":[{"code":"24538","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation ","code_information":[{"code":"28576","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulation ","code_information":[{"code":"28546","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each ","code_information":[{"code":"28456","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation ","code_information":[{"code":"28606","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws) ","code_information":[{"code":"27756","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of ulnar styloid fracture ","code_information":[{"code":"25651","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of ulnar styloid fracture ","code_information":[{"code":"25651","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each ","code_information":[{"code":"26727","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve ","code_information":[{"code":"499","type":"RC"},{"code":"93591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve ","code_information":[{"code":"481","type":"RC"},{"code":"93590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve ","code_information":[{"code":"490","type":"RC"},{"code":"93590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve ","code_information":[{"code":"790","type":"RC"},{"code":"93590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transcatheter closure of patent ductus arteriosus ","code_information":[{"code":"790","type":"RC"},{"code":"93582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angi ","code_information":[{"code":"369","type":"RC"},{"code":"36904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":20461.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angi ","code_information":[{"code":"36906","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":20461.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20461.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16954.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during cours ","code_information":[{"code":"37188","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, i ","code_information":[{"code":"92938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6243.00,"maximum":41198.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":17846.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":20326.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":14886.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8300.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7500.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8100.00,"methodology":"case rate"}]}]},{"description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation ","code_information":[{"code":"21355","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation ","code_information":[{"code":"21355","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation ","code_information":[{"code":"21355","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Percutaneous treatment of mandibular fracture, with external fixation ","code_information":[{"code":"21452","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus ","code_information":[{"code":"21340","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or b ","code_information":[{"code":"22513","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16235.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11654.00,"methodology":"case rate"}]}]},{"description":"Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or b ","code_information":[{"code":"22514","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16235.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11654.00,"methodology":"case rate"}]}]},{"description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic ","code_information":[{"code":"22510","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16235.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11654.00,"methodology":"case rate"}]}]},{"description":"Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral ","code_information":[{"code":"22511","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16235.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11654.00,"methodology":"case rate"}]}]},{"description":"PERICARDIOCENTESIS; SUBSEQUENT ","code_information":[{"code":"33011","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"Periodontal mucosal grafting ","code_information":[{"code":"41870","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Periodontal mucosal grafting ","code_information":[{"code":"41870","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach ","code_information":[{"code":"21261","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach ","code_information":[{"code":"21260","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement ","code_information":[{"code":"21263","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"PERIPH FIELD STIMUL REVISE ","code_information":[{"code":"0284T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"Perirectal injection of sclerosing solution for prolapse ","code_information":[{"code":"45520","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Phalangectomy, toe, each toe ","code_information":[{"code":"28150","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Pharyngoplasty (plastic or reconstructive operation on pharynx) ","code_information":[{"code":"369","type":"RC"},{"code":"42950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"PHENOXYBENZAMINE 10MG PO ","code_information":[{"code":"13063","type":"CDM"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":249.42,"discounted_cash":249.42,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":44.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":62.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":54.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":37.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":55.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":49.63,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":199.54,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":39.91,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":57.37,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":52.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":84.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":57.37,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":42.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":212.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":187.06,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":23.20,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":199.54,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":212.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":124.71,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":33.67,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":361.66,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":71.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":112.24,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":63.10,"methodology":"percent of total billed charges"}]}]},{"description":"PHENYLEPHRIN 2.5% OP 3ML ","code_information":[{"code":"10637","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":428.00,"discounted_cash":428.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":70.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":32.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":81.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":61.63,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":77.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":107.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":94.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":55.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":35.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":30.82,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":64.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":94.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":85.17,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":342.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":68.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":98.44,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":89.88,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":145.52,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":98.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":72.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":363.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":321.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":39.80,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":55.64,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":342.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":363.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":57.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":620.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":121.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":192.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":108.28,"methodology":"percent of total billed charges"}]}]},{"description":"Phospholipid neutralization; platelet ","code_information":[{"code":"85597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.08,"maximum":26.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.40,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day ","code_information":[{"code":"361","type":"RC"},{"code":"96567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Photopheresis, extracorporeal ","code_information":[{"code":"361","type":"RC"},{"code":"36522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"PHP GRP W PT 45 MIN ","code_information":[{"code":"795063","type":"CDM"},{"code":"G0410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":818.00,"discounted_cash":818.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":147.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":204.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":179.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":106.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":409.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":122.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":180.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":162.78,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":409.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":409.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":130.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":188.14,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":171.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":278.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":188.14,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":139.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":695.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":613.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":76.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":106.34,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":409.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":654.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":695.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":409.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":110.43,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1186.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":368.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":206.95,"methodology":"percent of total billed charges"}]}]},{"description":"Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) ","code_information":[{"code":"750","type":"RC"},{"code":"93464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"PIN BN TEMP 4MM 140MM ","code_information":[{"code":"904796","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":229.00,"discounted_cash":229.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":37.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":43.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":41.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":57.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":50.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":29.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":19.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":16.49,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":34.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":50.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":45.57,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":183.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":36.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":52.67,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":48.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":77.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":52.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":38.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":194.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":171.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":21.30,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":29.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":183.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":194.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":114.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":30.91,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":332.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":65.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":103.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":57.94,"methodology":"percent of total billed charges"}]}]},{"description":"PIN DRL KN ACL 4MM ","code_information":[{"code":"873846","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN EXFX THRD 3/16X9IN ","code_information":[{"code":"916891","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":471.00,"discounted_cash":471.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":77.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":35.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":89.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":67.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":84.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":117.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":103.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":61.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":39.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":33.91,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":70.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":104.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":93.73,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":376.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":75.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":108.33,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":98.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":160.14,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":108.33,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":80.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":400.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":353.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":43.80,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":61.23,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":376.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":400.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":235.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":63.59,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":682.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":134.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":211.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":119.16,"methodology":"percent of total billed charges"}]}]},{"description":"PIN EXFX THRD 3/32X9IN ","code_information":[{"code":"916890","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX 2.4MM 229MM ","code_information":[{"code":"825934","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":960.00,"discounted_cash":960.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":158.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":72.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":183.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":138.24,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":172.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":240.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":211.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":124.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":79.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":69.12,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":144.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":212.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":191.04,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":768.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":153.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":220.80,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":326.40,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":220.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":163.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":816.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":720.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":89.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":124.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":768.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":816.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":129.60,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1392.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":273.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":432.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":242.88,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX 2.5MM 14MM ","code_information":[{"code":"914602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX EX FIX 110X3MM SS ","code_information":[{"code":"892158","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX MIDLINE HEXALOBE ","code_information":[{"code":"942311","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":774.00,"discounted_cash":774.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":127.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":58.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":147.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":111.46,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":139.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":193.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":170.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":100.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":64.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":55.73,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":116.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":171.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":154.03,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":619.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":123.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":178.02,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":162.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":263.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":178.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":131.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":657.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":580.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":71.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":100.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":619.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":657.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":387.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":104.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1122.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":220.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":348.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":195.82,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX STNM 2.5X100MM ","code_information":[{"code":"832143","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":867.00,"discounted_cash":867.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":143.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":65.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":165.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":124.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":156.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":216.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":190.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":112.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":71.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":62.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":130.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":191.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":172.53,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":693.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":138.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":199.41,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":182.07,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":294.78,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":199.41,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":147.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":736.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":650.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":80.63,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":112.71,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":693.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":736.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":433.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":117.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1257.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":247.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":390.15,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":219.35,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX STRL 3.2X140MM ","code_information":[{"code":"918269","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN FX THRD LONG ","code_information":[{"code":"892872","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":929.00,"discounted_cash":929.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":153.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":69.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":177.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":133.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":167.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":232.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":204.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":120.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":77.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":66.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":139.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":205.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":184.87,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":743.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":148.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":213.67,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":315.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":213.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":157.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":789.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":696.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":86.40,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":120.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":743.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":789.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":125.42,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1347.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":264.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":418.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":235.04,"methodology":"percent of total billed charges"}]}]},{"description":"PIN HLF 250X6 APX EX FIX ","code_information":[{"code":"887931","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN POST MT EXFX 2 HIGH ","code_information":[{"code":"931706","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN SET BN MOD GLND ","code_information":[{"code":"909706","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":4205.00,"discounted_cash":4205.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":693.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":315.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":803.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":605.52,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":756.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1051.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":925.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":546.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":349.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":302.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":630.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":929.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":836.79,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3364.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":672.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":967.15,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":883.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1429.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":967.15,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":714.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3574.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3153.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":391.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":546.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3364.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3574.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":567.67,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6097.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1198.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1892.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1063.87,"methodology":"percent of total billed charges"}]}]},{"description":"PIN SKULL DISP 1.285IN ","code_information":[{"code":"822706","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":563.00,"discounted_cash":563.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":92.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":42.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":107.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":81.07,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":101.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":140.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":123.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":73.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":46.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":40.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":84.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":124.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":112.04,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":450.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":90.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":129.49,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":118.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":191.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":129.49,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":95.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":478.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":422.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":52.36,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":73.19,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":450.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":478.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":281.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":76.00,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":816.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":160.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":253.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":142.44,"methodology":"percent of total billed charges"}]}]},{"description":"PIN SPNL PERC DISP 125MM ","code_information":[{"code":"926989","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN TEMP FIX SM 1.4MM ","code_information":[{"code":"861252","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":929.00,"discounted_cash":929.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":153.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":69.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":177.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":133.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":167.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":232.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":204.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":120.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":77.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":66.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":139.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":205.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":184.87,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":743.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":148.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":213.67,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":195.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":315.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":213.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":157.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":789.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":696.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":86.40,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":120.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":743.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":789.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":464.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":125.42,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1347.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":264.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":418.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":235.04,"methodology":"percent of total billed charges"}]}]},{"description":"PIN TEMP FIXTN 1.1X10MM ","code_information":[{"code":"899143","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN TEMP PLT RETAINING ","code_information":[{"code":"922526","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"PIN THRD DISP 5X175MM ","code_information":[{"code":"927061","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"PL DEV OT AB/PL/PROS/THR ","code_information":[{"code":"791888","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":6495.00,"discounted_cash":6495.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":487.13,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1169.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":539.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":467.64,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":974.25,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5196.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1039.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1493.85,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1493.85,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1104.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5520.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4871.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":604.04,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5196.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5520.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3247.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":876.83,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9417.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2922.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1643.23,"methodology":"percent of total billed charges"}]}]},{"description":"PLACE NG/OG TUBE FLUORO ","code_information":[{"code":"588257","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1342.00,"discounted_cash":1342.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":100.65,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":241.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":111.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":96.62,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":201.30,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1073.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":214.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":308.66,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":308.66,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":228.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1140.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":124.81,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1073.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1140.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":671.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":181.17,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1945.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":603.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":339.53,"methodology":"percent of total billed charges"}]}]},{"description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (List ","code_information":[{"code":"0222T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar ","code_information":[{"code":"0221T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Placement of amniotic membrane on the ocular surface; single layer, sutured ","code_information":[{"code":"360","type":"RC"},{"code":"65779","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Placement of amniotic membrane on the ocular surface; single layer, sutured ","code_information":[{"code":"65779","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervi ","code_information":[{"code":"47533","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervi ","code_information":[{"code":"47534","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in a ","code_information":[{"code":"19288","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance ","code_information":[{"code":"19287","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance ","code_information":[{"code":"19287","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in additi ","code_information":[{"code":"19284","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition ","code_information":[{"code":"19286","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance ","code_information":[{"code":"19281","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance ","code_information":[{"code":"19281","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance ","code_information":[{"code":"19283","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance ","code_information":[{"code":"19285","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance ","code_information":[{"code":"19285","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of endorectal intracavitary applicator for high intensity brachytherapy ","code_information":[{"code":"361","type":"RC"},{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or m ","code_information":[{"code":"361","type":"RC"},{"code":"49411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple ","code_information":[{"code":"32553","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple ","code_information":[{"code":"481","type":"RC"},{"code":"55876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple ","code_information":[{"code":"55876","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair lumbar hernia ","code_information":[{"code":"360","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair lumbar hernia ","code_information":[{"code":"481","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair medial collateral ligament, elbow, with local tissue ","code_information":[{"code":"24345","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair medial collateral ligament, elbow, with local tissue ","code_information":[{"code":"24345","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair nasal septal perforations ","code_information":[{"code":"30630","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation) ","code_information":[{"code":"26546","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator ","code_information":[{"code":"33220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":25915.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":30246.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":18208.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22680.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22228.00,"methodology":"case rate"}]}]},{"description":"Repair of anal fistula with fibrin glue ","code_information":[{"code":"46706","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of anorectal fistula with plug (eg, porcine small intestine submucosa ºSIS») ","code_information":[{"code":"46707","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of anterior palate, including vomer flap ","code_information":[{"code":"42235","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; (tarso) levator resection or advancement, external approach ","code_information":[{"code":"67904","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach ","code_information":[{"code":"360","type":"RC"},{"code":"67903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) ","code_information":[{"code":"67908","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) ","code_information":[{"code":"67901","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) ","code_information":[{"code":"360","type":"RC"},{"code":"67906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) ","code_information":[{"code":"67900","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of defect with autograft; radius AND ulna ","code_information":[{"code":"25426","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of defect with autograft; radius OR ulna ","code_information":[{"code":"25425","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of defect with autograft; radius OR ulna ","code_information":[{"code":"25425","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of ectropion; thermocauterization ","code_information":[{"code":"67915","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of enterocele, abdominal approach (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"57270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of enterocele, vaginal approach (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"57268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of enterocele, vaginal approach (separate procedure) ","code_information":[{"code":"57268","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of entropion; excision tarsal wedge ","code_information":[{"code":"67923","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) ","code_information":[{"code":"67924","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of entropion; thermocauterization ","code_information":[{"code":"369","type":"RC"},{"code":"67922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each finger ","code_information":[{"code":"26428","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft) ","code_information":[{"code":"26434","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft) ","code_information":[{"code":"26434","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft) ","code_information":[{"code":"26434","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger) ","code_information":[{"code":"26433","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair of fibula nonunion and/or malunion with internal fixation ","code_information":[{"code":"27726","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple ","code_information":[{"code":"481","type":"RC"},{"code":"54340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple ","code_information":[{"code":"490","type":"RC"},{"code":"54340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring extensive dissection, and urethroplasty with flap, patch or tubed graft (including urinary diversion, when perfor ","code_information":[{"code":"360","type":"RC"},{"code":"54348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring extensive dissection, and urethroplasty with flap, patch or tubed graft (including urinary diversion, when perfor ","code_information":[{"code":"481","type":"RC"},{"code":"54348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft ","code_information":[{"code":"360","type":"RC"},{"code":"54344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff ","code_information":[{"code":"369","type":"RC"},{"code":"53449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of iris, ciliary body (as for iridodialysis) ","code_information":[{"code":"66680","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue ","code_information":[{"code":"41250","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue ","code_information":[{"code":"41250","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization ","code_information":[{"code":"369","type":"RC"},{"code":"65272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure ","code_information":[{"code":"360","type":"RC"},{"code":"65270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure ","code_information":[{"code":"65270","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue ","code_information":[{"code":"361","type":"RC"},{"code":"65280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue ","code_information":[{"code":"490","type":"RC"},{"code":"65285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; cornea, nonperforating, with or without removal foreign body ","code_information":[{"code":"360","type":"RC"},{"code":"65275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of laceration; cornea, nonperforating, with or without removal foreign body ","code_information":[{"code":"65275","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of nail bed ","code_information":[{"code":"11760","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) ","code_information":[{"code":"30465","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of nasolabial fistula ","code_information":[{"code":"369","type":"RC"},{"code":"42260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone ","code_information":[{"code":"25431","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft) ","code_information":[{"code":"24435","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, humerus; without graft (eg, compression technique) ","code_information":[{"code":"24430","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, humerus; without graft (eg, compression technique) ","code_information":[{"code":"24430","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius AND ulna; with autograft (includes obtaining graft) ","code_information":[{"code":"25420","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique) ","code_information":[{"code":"25415","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique) ","code_information":[{"code":"25415","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique) ","code_information":[{"code":"25415","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft) ","code_information":[{"code":"25405","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft) ","code_information":[{"code":"25405","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique) ","code_information":[{"code":"25400","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, tibia; with sliding graft ","code_information":[{"code":"27722","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion or malunion, tibia; without graft, (eg, compression technique) ","code_information":[{"code":"27720","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation) ","code_information":[{"code":"25440","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of patent ductus arteriosus; by division, 18 years and older ","code_information":[{"code":"33824","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Repair of patent ductus arteriosus; by division, 18 years and older ","code_information":[{"code":"33824","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":13778.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Repair of patent ductus arteriosus; by division, 18 years and older ","code_information":[{"code":"33824","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Repair of patent ductus arteriosus; by ligation ","code_information":[{"code":"33820","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Repair of patent ductus arteriosus; by ligation ","code_information":[{"code":"33820","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":13778.00,"maximum":29295.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29295.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":20730.00,"methodology":"case rate"}]}]},{"description":"Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation ","code_information":[{"code":"67105","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral bucklin ","code_information":[{"code":"490","type":"RC"},{"code":"67108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic ","code_information":[{"code":"23412","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT ","code_information":[{"code":"66220","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"Repair of spica, body cast or jacket ","code_information":[{"code":"29720","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair of spica, body cast or jacket ","code_information":[{"code":"29720","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair of symblepharon; conjunctivoplasty, without graft ","code_information":[{"code":"68330","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens ","code_information":[{"code":"481","type":"RC"},{"code":"68340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens ","code_information":[{"code":"490","type":"RC"},{"code":"68340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft) ","code_information":[{"code":"360","type":"RC"},{"code":"68335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft) ","code_information":[{"code":"481","type":"RC"},{"code":"68335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails) ","code_information":[{"code":"26562","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair of syndactyly (web finger) each web space; with skin flaps ","code_information":[{"code":"26560","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair of traumatic corporeal tear(s) ","code_information":[{"code":"54437","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of tunica vaginalis hydrocele (Bottle type) ","code_information":[{"code":"499","type":"RC"},{"code":"55060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair of wound, extraocular muscle, tendon and/or Tenon's capsule ","code_information":[{"code":"65290","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon ","code_information":[{"code":"26370","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26372","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26372","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26358","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26358","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26358","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon ","code_information":[{"code":"26350","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26352","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair oval window fistula ","code_information":[{"code":"69666","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; incarcerated or strangulated ","code_information":[{"code":"49557","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; reducible ","code_information":[{"code":"490","type":"RC"},{"code":"49555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED ","code_information":[{"code":"481","type":"RC"},{"code":"49566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED ","code_information":[{"code":"490","type":"RC"},{"code":"49566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE ","code_information":[{"code":"49565","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent inguinal hernia, any age; reducible ","code_information":[{"code":"360","type":"RC"},{"code":"49520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair round window fistula ","code_information":[{"code":"69667","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ","code_information":[{"code":"369","type":"RC"},{"code":"49585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; REDUCIBLE ","code_information":[{"code":"49580","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR VENOUS BLOCKAGE ","code_information":[{"code":"35460","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"REPAIR VENOUS BLOCKAGE ","code_information":[{"code":"35476","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"REPAIR VENOUS BLOCKAGE ","code_information":[{"code":"35476","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; extremities ","code_information":[{"code":"35190","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; head and neck ","code_information":[{"code":"35188","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; head and neck ","code_information":[{"code":"35188","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; head and neck ","code_information":[{"code":"35188","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm ","code_information":[{"code":"13151","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm ","code_information":[{"code":"13152","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm ","code_information":[{"code":"13131","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm ","code_information":[{"code":"13131","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm ","code_information":[{"code":"13132","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13133","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm ","code_information":[{"code":"13121","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13122","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 1.1 cm to 2.5 cm ","code_information":[{"code":"13100","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 2.6 cm to 7.5 cm ","code_information":[{"code":"13101","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; without fibular osteotomy ","code_information":[{"code":"27675","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon ","code_information":[{"code":"26418","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26412","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon ","code_information":[{"code":"26410","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27665","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, fascial defect of leg ","code_information":[{"code":"27656","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27659","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27659","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27659","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"490","type":"RC"},{"code":"49495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"49496","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or stra ","code_information":[{"code":"369","type":"RC"},{"code":"49492","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible ","code_information":[{"code":"49491","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less ","code_information":[{"code":"12051","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12056","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12056","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm ","code_information":[{"code":"12057","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less ","code_information":[{"code":"12041","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm ","code_information":[{"code":"12044","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0 cm ","code_information":[{"code":"12047","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12035","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12035","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12035","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less ","code_information":[{"code":"12031","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm ","code_information":[{"code":"12032","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm ","code_information":[{"code":"12036","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm ","code_information":[{"code":"12034","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm ","code_information":[{"code":"12037","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm ","code_information":[{"code":"12037","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, intrinsic muscles of hand, each muscle ","code_information":[{"code":"26591","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, laceration of palate; over 2 cm or complex ","code_information":[{"code":"42182","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, laceration of palate; up to 2 cm ","code_information":[{"code":"42180","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft) ","code_information":[{"code":"28322","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; tarsal bones ","code_information":[{"code":"28320","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments ","code_information":[{"code":"27696","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments ","code_information":[{"code":"27696","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments ","code_information":[{"code":"27696","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, open or percutaneous, ruptured Achilles tendon; ","code_information":[{"code":"27650","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) ","code_information":[{"code":"27652","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) ","code_information":[{"code":"27652","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments ","code_information":[{"code":"27409","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments ","code_information":[{"code":"27409","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; cruciate ","code_information":[{"code":"27407","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) ","code_information":[{"code":"27698","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle ","code_information":[{"code":"25270","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle ","code_information":[{"code":"25260","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25265","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25265","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation) ","code_information":[{"code":"25275","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft) ","code_information":[{"code":"28210","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon ","code_information":[{"code":"28200","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft) ","code_information":[{"code":"28202","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft) ","code_information":[{"code":"28202","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor ","code_information":[{"code":"369","type":"RC"},{"code":"69717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR; WITH MASTOIDECTOMY ","code_information":[{"code":"361","type":"RC"},{"code":"69718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11482.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"}]}]},{"description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"361","type":"RC"},{"code":"49451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"481","type":"RC"},{"code":"49451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of tissue expander with permanent implant ","code_information":[{"code":"11970","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replacement or irrigation, subarachnoid/subdural catheter ","code_information":[{"code":"499","type":"RC"},{"code":"62194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Replacement or irrigation, ventricular catheter ","code_information":[{"code":"499","type":"RC"},{"code":"62225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system ","code_information":[{"code":"369","type":"RC"},{"code":"62230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, an ","code_information":[{"code":"36584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Replacement, irrigation or revision of lumbosubarachnoid shunt ","code_information":[{"code":"63744","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation ","code_information":[{"code":"20822","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition ","code_information":[{"code":"43761","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and im ","code_information":[{"code":"360","type":"RC"},{"code":"37192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPOSITIONING OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; SENSING LEAD ONLY ","code_information":[{"code":"0433T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPOSITIONING OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; STIMULATION LEAD ONLY ","code_information":[{"code":"0432T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPOSITIONING OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; STIMULATION LEAD ONLY ","code_information":[{"code":"0432T","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted subcutaneous implantable defibrillator electrode ","code_information":[{"code":"33273","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted subcutaneous implantable defibrillator electrode ","code_information":[{"code":"33273","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode ","code_information":[{"code":"33215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":25915.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":30246.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":18208.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":29413.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22680.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22228.00,"methodology":"case rate"}]}]},{"description":"Reprogramming of programmable cerebrospinal shunt ","code_information":[{"code":"369","type":"RC"},{"code":"62252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Reptilase test ","code_information":[{"code":"85635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.36,"maximum":14.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"}]}]},{"description":"Resection of elbow joint (arthrectomy) ","code_information":[{"code":"24155","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls ","code_information":[{"code":"42892","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Resection of lip, more than one-fourth, without reconstruction ","code_information":[{"code":"369","type":"RC"},{"code":"40530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection of scrotum ","code_information":[{"code":"360","type":"RC"},{"code":"55150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Resection or transplantation of long tendon of biceps ","code_information":[{"code":"23440","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection or transplantation of long tendon of biceps ","code_information":[{"code":"23440","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection, humeral head ","code_information":[{"code":"23195","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection, humeral head ","code_information":[{"code":"23195","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Resection, partial or complete, phalangeal base, each toe ","code_information":[{"code":"28126","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC ","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40209.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18030.80,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":18646.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20543.47,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":18118.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":17766.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17766.93,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17119.56,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19350.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":28277.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40209.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":17942.84,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17942.84,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":19174.21,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18646.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":19701.94,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":18294.66,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17063.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18294.66,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":17942.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":18998.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21988.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14337.37,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18294.66,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":16711.47,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18294.66,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":18998.30,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19350.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18118.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429202.00, reimbursement will be $9546 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":16764.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5442.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7807 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17591.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17063.29,"methodology":"fee schedule"}]}]},{"description":"RETRACTOR SURG 7.5IN ","code_information":[{"code":"897555","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2891.00,"discounted_cash":2891.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":477.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":216.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":552.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":416.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":520.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":722.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":636.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":375.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":239.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":208.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":433.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":638.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":575.31,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2312.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":462.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":664.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":607.11,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":982.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":664.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":491.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2457.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2168.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":268.86,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":375.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2312.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2457.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1445.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":390.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4191.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":823.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1300.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":731.42,"methodology":"percent of total billed charges"}]}]},{"description":"RETRCTR WND MED 5-9CM ","code_information":[{"code":"833356","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2013.00,"discounted_cash":2013.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":332.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":150.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":384.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":289.87,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":362.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":503.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":442.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":261.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":167.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":144.94,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":301.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":444.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":400.59,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1610.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":322.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":462.99,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":684.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":462.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":342.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1711.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1509.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":187.21,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":261.69,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1610.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1711.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1006.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":271.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2918.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":573.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":905.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":509.29,"methodology":"percent of total billed charges"}]}]},{"description":"RETRCTR WND XSM 2-4CM ","code_information":[{"code":"937632","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1920.00,"discounted_cash":1920.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":316.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":144.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":366.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":276.48,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":345.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":480.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":422.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":249.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":159.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":138.24,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":288.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":424.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":382.08,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1536.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":307.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":441.60,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":403.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":652.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":441.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":326.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1632.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1440.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":178.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":249.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1536.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1632.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":960.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":259.20,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2784.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":547.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":864.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":485.76,"methodology":"percent of total billed charges"}]}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, ","code_information":[{"code":"361","type":"RC"},{"code":"37193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, ","code_information":[{"code":"37193","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; alcohol ","code_information":[{"code":"499","type":"RC"},{"code":"67505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Retrobulbar injection; medication (separate procedure, does not include supply of medication) ","code_information":[{"code":"490","type":"RC"},{"code":"67500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"RETROCUTTER AR-1204RD09S ","code_information":[{"code":"818992","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3322.00,"discounted_cash":3322.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":548.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":249.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":634.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":478.37,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":597.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":830.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":730.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":431.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":275.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":239.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":498.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":734.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":661.08,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2657.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":531.52,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":764.06,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":697.62,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1129.48,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":764.06,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":564.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2823.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2491.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":308.95,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":431.86,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2657.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2823.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1661.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":448.47,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4816.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":946.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1494.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":840.47,"methodology":"percent of total billed charges"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when ","code_information":[{"code":"360","type":"RC"},{"code":"37227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":35200.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35200.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":27095.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"37222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when p ","code_information":[{"code":"37223","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty ","code_information":[{"code":"37220","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty ","code_information":[{"code":"37228","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when perf ","code_information":[{"code":"37230","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List s ","code_information":[{"code":"361","type":"RC"},{"code":"37233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List s ","code_information":[{"code":"37233","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary proced ","code_information":[{"code":"369","type":"RC"},{"code":"37232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, wh ","code_information":[{"code":"37234","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"360","type":"RC"},{"code":"63663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"63663","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed ","code_information":[{"code":"63664","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12947.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in complete mastoidectomy ","code_information":[{"code":"490","type":"RC"},{"code":"69601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in modified radical mastoidectomy ","code_information":[{"code":"69602","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in radical mastoidectomy ","code_information":[{"code":"69603","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in tympanoplasty ","code_information":[{"code":"360","type":"RC"},{"code":"69604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision mastoidectomy; resulting in tympanoplasty ","code_information":[{"code":"69604","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"REVISION MASTOIDECTOMY; WITH APICECTOMY ","code_information":[{"code":"360","type":"RC"},{"code":"69605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft ","code_information":[{"code":"369","type":"RC"},{"code":"66185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft ","code_information":[{"code":"66184","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of arthroplasty, including removal of implant, wrist joint ","code_information":[{"code":"25449","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"44345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure) ","code_information":[{"code":"44345","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure) ","code_information":[{"code":"44345","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; simple (release of superficial scar) (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"44340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of colostomy; with repair of paracolostomy hernia (separate procedure) ","code_information":[{"code":"44346","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC ","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":54804.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":41767.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41962.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":44644.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":33494.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":43395.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":50066.78,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":42167.56,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":50248.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":45660.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":45660.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":45660.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":45660.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":46136.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":28265.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":45660.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":41348.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41348.77,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":41722.32,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":45033.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":30137.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":36917.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":41758.17,"methodology":"fee schedule"},{"payer_name":"Department of Juvenile Justice","plan_name":"MCD","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":41758.17,"methodology":"fee schedule"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":44623.92,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43395.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":45852.11,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":42576.96,"methodology":"fee schedule"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":39711.20,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42576.96,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":15050.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":41758.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":44214.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51174.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":34941.80,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":42576.96,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":38892.41,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":42576.96,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":44214.53,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":112.00,"standard_charge_algorithm":"Reimbursement will be 112% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":45033.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":42167.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":54804.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":39015.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":45217.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":40939.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39711.20,"methodology":"fee schedule"}]}]},{"description":"Revision of ileostomy; simple (release of superficial scar) (separate procedure) ","code_information":[{"code":"44312","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REVISION OF LARYNX ","code_information":[{"code":"31588","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":14492.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"Revision of peritoneal-venous shunt ","code_information":[{"code":"361","type":"RC"},{"code":"49426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue exc ","code_information":[{"code":"19380","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component ","code_information":[{"code":"24371","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":26434.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26434.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18700.00,"methodology":"case rate"}]}]},{"description":"Revision of tracheostomy scar ","code_information":[{"code":"31830","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of tracheostomy scar ","code_information":[{"code":"31830","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Revision of urinary-cutaneous anastomosis (any type urostomy); ","code_information":[{"code":"50727","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral ","code_information":[{"code":"0444T","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electroni ","code_information":[{"code":"361","type":"RC"},{"code":"93745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"INJ DISKOGRAM L-SPIN ","code_information":[{"code":"122878","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5891.00,"discounted_cash":5891.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":972.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":441.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1125.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":848.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1060.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2945.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":488.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":424.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2945.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2945.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4712.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1354.93,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5007.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4418.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":765.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2945.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4712.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5007.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2945.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1678.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2650.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1490.42,"methodology":"percent of total billed charges"}]}]},{"description":"INJ EPI NO SUB CT W IMAG ","code_information":[{"code":"792733","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":13406.00,"discounted_cash":13406.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1005.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2413.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":1112.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":965.23,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":2010.90,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10724.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":2144.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":3083.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3083.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":2279.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11395.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":10054.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1246.76,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10724.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11395.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6703.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":1809.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":19438.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6032.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3391.72,"methodology":"percent of total billed charges"}]}]},{"description":"INJ KNEE ARTHRO ","code_information":[{"code":"115907","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":6338.00,"discounted_cash":6338.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":475.35,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1140.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":526.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":456.34,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":950.70,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5070.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1014.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1457.74,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1457.74,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":1077.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5387.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4753.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":589.43,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5070.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5387.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3169.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":855.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9190.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2852.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1603.51,"methodology":"percent of total billed charges"}]}]},{"description":"INJ SCLEROS SOLSNG VN ","code_information":[{"code":"588233","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2701.00,"discounted_cash":2701.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":202.57,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":486.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":224.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":194.47,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":405.15,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2160.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":432.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":621.23,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":621.23,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":459.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2295.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2025.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":251.19,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2160.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2295.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1350.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":364.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3916.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1215.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":683.35,"methodology":"percent of total billed charges"}]}]},{"description":"INJECT SPINE CERV/THORACIC ","code_information":[{"code":"499","type":"RC"},{"code":"62310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"INJECT SPINE W/CATH CRV/THRC ","code_information":[{"code":"490","type":"RC"},{"code":"62318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"INJECT SPINE W/CATH LMB/SCRL ","code_information":[{"code":"499","type":"RC"},{"code":"62319","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"Injection into turbinate(s), therapeutic ","code_information":[{"code":"30200","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection into turbinate(s), therapeutic ","code_information":[{"code":"30200","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of air or contrast into peritoneal cavity (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"49400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of contrast medium for dacryocystography ","code_information":[{"code":"369","type":"RC"},{"code":"68850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of contrast medium for dacryocystography ","code_information":[{"code":"481","type":"RC"},{"code":"68850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of contrast medium for dacryocystography ","code_information":[{"code":"490","type":"RC"},{"code":"68850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine) ","code_information":[{"code":"54235","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of medication or other substance into Tenon's capsule ","code_information":[{"code":"369","type":"RC"},{"code":"67515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg ","code_information":[{"code":"361","type":"RC"},{"code":"36471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of sclerosant; single incompetent vein (other than telangiectasia) ","code_information":[{"code":"360","type":"RC"},{"code":"36470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of sclerosant; single incompetent vein (other than telangiectasia) ","code_information":[{"code":"36470","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of sinus tract; diagnostic (sinogram) ","code_information":[{"code":"20501","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection of sinus tract; diagnostic (sinogram) ","code_information":[{"code":"20501","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt ","code_information":[{"code":"49427","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt ","code_information":[{"code":"49427","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for p ","code_information":[{"code":"361","type":"RC"},{"code":"93568","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"93567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"93567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8919.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":7134.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":8919.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for ankle arthrography ","code_information":[{"code":"27648","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for ankle arthrography ","code_information":[{"code":"27648","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervisio ","code_information":[{"code":"50430","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervisio ","code_information":[{"code":"50431","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"47531","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"47531","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"47531","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"360","type":"RC"},{"code":"47532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"47532","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for corpora cavernosography ","code_information":[{"code":"369","type":"RC"},{"code":"54230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for corpora cavernosography ","code_information":[{"code":"481","type":"RC"},{"code":"54230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for cystography or voiding urethrocystography ","code_information":[{"code":"490","type":"RC"},{"code":"51600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for discography, each level; lumbar ","code_information":[{"code":"481","type":"RC"},{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for discography, each level; lumbar ","code_information":[{"code":"490","type":"RC"},{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for discography, each level; lumbar ","code_information":[{"code":"62290","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for discography, each level; lumbar ","code_information":[{"code":"62290","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for elbow arthrography ","code_information":[{"code":"24220","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for extremity venography (including introduction of needle or intracatheter) ","code_information":[{"code":"360","type":"RC"},{"code":"36005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for hip arthrography; with anesthesia ","code_information":[{"code":"27095","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for hip arthrography; with anesthesia ","code_information":[{"code":"27095","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for hip arthrography; without anesthesia ","code_information":[{"code":"27093","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for hip arthrography; without anesthesia ","code_information":[{"code":"27093","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for myelography and/or computed tomography, lumbar ","code_information":[{"code":"62284","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for Peyronie disease; with surgical exposure of plaque ","code_information":[{"code":"360","type":"RC"},{"code":"54205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for Peyronie disease; with surgical exposure of plaque ","code_information":[{"code":"499","type":"RC"},{"code":"54205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for sacroiliac joint; arthrography ","code_information":[{"code":"750","type":"RC"},{"code":"G0259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for sacroiliac joint; arthrography ","code_information":[{"code":"790","type":"RC"},{"code":"G0259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography ","code_information":[{"code":"499","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for sialography ","code_information":[{"code":"360","type":"RC"},{"code":"42550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for splenoportography ","code_information":[{"code":"38200","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for splenoportography ","code_information":[{"code":"38200","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for temporomandibular joint arthrography ","code_information":[{"code":"21116","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for temporomandibular joint arthrography ","code_information":[{"code":"21116","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service ","code_information":[{"code":"360","type":"RC"},{"code":"50690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure only for mammary ductogram or galactogram ","code_information":[{"code":"19030","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure only for mammary ductogram or galactogram ","code_information":[{"code":"19030","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure only for mammary ductogram or galactogram ","code_information":[{"code":"19030","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure only for mammary ductogram or galactogram ","code_information":[{"code":"19030","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal ","code_information":[{"code":"361","type":"RC"},{"code":"62294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal ","code_information":[{"code":"499","type":"RC"},{"code":"62294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection procedure; lymphangiography ","code_information":[{"code":"360","type":"RC"},{"code":"38790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedure; radioactive tracer for identification of sentinel node ","code_information":[{"code":"38792","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection procedures (eg, thrombin) for percutaneous treatment of extremity pseudoaneurysm ","code_information":[{"code":"36002","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk ","code_information":[{"code":"361","type":"RC"},{"code":"36468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE ","code_information":[{"code":"0229T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; SINGLE LEVEL ","code_information":[{"code":"0228T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ","code_information":[{"code":"0231T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2772.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; SINGLE LEVEL ","code_information":[{"code":"0230T","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3150.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed ","code_information":[{"code":"360","type":"RC"},{"code":"64417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed ","code_information":[{"code":"490","type":"RC"},{"code":"64416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed ","code_information":[{"code":"369","type":"RC"},{"code":"64448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed ","code_information":[{"code":"481","type":"RC"},{"code":"64448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed ","code_information":[{"code":"490","type":"RC"},{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed ","code_information":[{"code":"64447","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed ","code_information":[{"code":"64447","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"64421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level ","code_information":[{"code":"369","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level ","code_information":[{"code":"481","type":"RC"},{"code":"64420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) ","code_information":[{"code":"369","type":"RC"},{"code":"64449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) ","code_information":[{"code":"481","type":"RC"},{"code":"64449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) ","code_information":[{"code":"490","type":"RC"},{"code":"64449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) ","code_information":[{"code":"64449","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch ","code_information":[{"code":"64450","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch ","code_information":[{"code":"64450","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; paracervical (uterine) nerve ","code_information":[{"code":"490","type":"RC"},{"code":"64435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve ","code_information":[{"code":"64430","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve ","code_information":[{"code":"64430","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed ","code_information":[{"code":"361","type":"RC"},{"code":"64446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed ","code_information":[{"code":"369","type":"RC"},{"code":"64445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code f ","code_information":[{"code":"369","type":"RC"},{"code":"64480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code f ","code_information":[{"code":"481","type":"RC"},{"code":"64480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code f ","code_information":[{"code":"490","type":"RC"},{"code":"64480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level ","code_information":[{"code":"361","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level ","code_information":[{"code":"499","type":"RC"},{"code":"64479","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for p ","code_information":[{"code":"361","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for p ","code_information":[{"code":"499","type":"RC"},{"code":"64484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level ","code_information":[{"code":"361","type":"RC"},{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular) ","code_information":[{"code":"360","type":"RC"},{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; vagus nerve ","code_information":[{"code":"64408","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; vagus nerve ","code_information":[{"code":"64408","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon ","code_information":[{"code":"26357","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon ","code_information":[{"code":"26357","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon ","code_information":[{"code":"26357","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon ","code_information":[{"code":"26350","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon ","code_information":[{"code":"26350","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon ","code_information":[{"code":"26350","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair oval window fistula ","code_information":[{"code":"481","type":"RC"},{"code":"69666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; incarcerated or strangulated ","code_information":[{"code":"369","type":"RC"},{"code":"49557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; incarcerated or strangulated ","code_information":[{"code":"481","type":"RC"},{"code":"49557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; incarcerated or strangulated ","code_information":[{"code":"490","type":"RC"},{"code":"49557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; incarcerated or strangulated ","code_information":[{"code":"49557","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; reducible ","code_information":[{"code":"369","type":"RC"},{"code":"49555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent femoral hernia; reducible ","code_information":[{"code":"481","type":"RC"},{"code":"49555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED ","code_information":[{"code":"361","type":"RC"},{"code":"49566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE ","code_information":[{"code":"49565","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair recurrent inguinal hernia, any age; incarcerated or strangulated ","code_information":[{"code":"360","type":"RC"},{"code":"49521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPAIR SPIGELIAN HERNIA ","code_information":[{"code":"361","type":"RC"},{"code":"49590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR SPIGELIAN HERNIA ","code_information":[{"code":"49590","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ","code_information":[{"code":"49585","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE ","code_information":[{"code":"49585","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; INCARCERATED OR STRANGULATED ","code_information":[{"code":"49582","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; INCARCERATED OR STRANGULATED ","code_information":[{"code":"49582","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL HERNIA, YOUNGER THAN AGE 5 YEARS; REDUCIBLE ","code_information":[{"code":"369","type":"RC"},{"code":"49580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; extremities ","code_information":[{"code":"35190","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, acquired or traumatic arteriovenous fistula; extremities ","code_information":[{"code":"35190","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13153","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13153","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm ","code_information":[{"code":"13131","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm ","code_information":[{"code":"13120","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm ","code_information":[{"code":"13120","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm ","code_information":[{"code":"13120","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm ","code_information":[{"code":"13121","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 1.1 cm to 2.5 cm ","code_information":[{"code":"13100","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 1.1 cm to 2.5 cm ","code_information":[{"code":"13100","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 1.1 cm to 2.5 cm ","code_information":[{"code":"13100","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 2.6 cm to 7.5 cm ","code_information":[{"code":"13101","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 2.6 cm to 7.5 cm ","code_information":[{"code":"13101","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13102","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, congenital arteriovenous fistula; extremities ","code_information":[{"code":"35184","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, congenital arteriovenous fistula; extremities ","code_information":[{"code":"35184","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, congenital arteriovenous fistula; head and neck ","code_information":[{"code":"35180","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":5239.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; with fibular osteotomy ","code_information":[{"code":"27676","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; with fibular osteotomy ","code_information":[{"code":"27676","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; without fibular osteotomy ","code_information":[{"code":"27675","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; without fibular osteotomy ","code_information":[{"code":"27675","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon ","code_information":[{"code":"26420","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon ","code_information":[{"code":"26420","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon ","code_information":[{"code":"26420","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon ","code_information":[{"code":"26420","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26412","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, leg; primary, without graft, each tendon ","code_information":[{"code":"27664","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, leg; primary, without graft, each tendon ","code_information":[{"code":"27664","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27665","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, fascial defect of leg ","code_information":[{"code":"27656","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, fascial defect of leg ","code_information":[{"code":"27656","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; primary, without graft, each tendon ","code_information":[{"code":"27658","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; primary, without graft, each tendon ","code_information":[{"code":"27658","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27659","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"49495","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"369","type":"RC"},{"code":"49496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"481","type":"RC"},{"code":"49496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"490","type":"RC"},{"code":"49496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or with ","code_information":[{"code":"49496","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or stra ","code_information":[{"code":"49492","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or stra ","code_information":[{"code":"49492","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12055","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12055","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less ","code_information":[{"code":"12051","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12056","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12056","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm ","code_information":[{"code":"12053","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm ","code_information":[{"code":"12057","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm ","code_information":[{"code":"12045","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm ","code_information":[{"code":"12045","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm ","code_information":[{"code":"12042","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm ","code_information":[{"code":"12046","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm ","code_information":[{"code":"12046","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm ","code_information":[{"code":"12046","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm ","code_information":[{"code":"12046","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12035","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12035","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less ","code_information":[{"code":"12031","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm ","code_information":[{"code":"12032","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm ","code_information":[{"code":"12037","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Repair, laceration of palate; over 2 cm or complex ","code_information":[{"code":"360","type":"RC"},{"code":"42182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, laceration of palate; up to 2 cm ","code_information":[{"code":"369","type":"RC"},{"code":"42180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft) ","code_information":[{"code":"28322","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft) ","code_information":[{"code":"28322","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft) ","code_information":[{"code":"28322","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, nonunion or malunion; tarsal bones ","code_information":[{"code":"28320","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral ","code_information":[{"code":"27695","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral ","code_information":[{"code":"27695","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral ","code_information":[{"code":"27695","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral ","code_information":[{"code":"27695","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8652.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; cruciate ","code_information":[{"code":"27407","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; cruciate ","code_information":[{"code":"27407","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; cruciate ","code_information":[{"code":"27407","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; cruciate ","code_information":[{"code":"27407","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Repair, secondary, Achilles tendon, with or without graft ","code_information":[{"code":"27654","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle ","code_information":[{"code":"25270","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle ","code_information":[{"code":"25270","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25272","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25274","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25274","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25274","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25274","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle ","code_information":[{"code":"25260","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25265","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle ","code_information":[{"code":"25265","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff) ","code_information":[{"code":"24341","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation) ","code_information":[{"code":"25275","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, extensor, foot; primary or secondary, each tendon ","code_information":[{"code":"28208","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, extensor, foot; primary or secondary, each tendon ","code_information":[{"code":"28208","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, extensor, foot; primary or secondary, each tendon ","code_information":[{"code":"28208","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, extensor, foot; primary or secondary, each tendon ","code_information":[{"code":"28208","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon ","code_information":[{"code":"28200","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE), OSSEOINTEGRATED IMPLANT, TEMPORAL BONE, WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR; WITH MASTOIDECTOMY ","code_information":[{"code":"499","type":"RC"},{"code":"69718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11482.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11482.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"}]}]},{"description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"490","type":"RC"},{"code":"49451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49451","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"490","type":"RC"},{"code":"49452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49452","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49452","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement or irrigation, ventricular catheter ","code_information":[{"code":"62225","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site ","code_information":[{"code":"36578","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Replacement, irrigation or revision of lumbosubarachnoid shunt ","code_information":[{"code":"360","type":"RC"},{"code":"63744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation ","code_information":[{"code":"20822","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"REPO IVC FILTER W IMAG ","code_information":[{"code":"595823","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":32249.00,"discounted_cash":32249.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2418.68,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5804.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":2676.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":2321.93,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":4837.35,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":25799.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":5159.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7417.27,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7417.27,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":5482.33,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27411.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":24186.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2999.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":25799.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27411.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16124.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":4353.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":46761.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14512.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":8159.00,"methodology":"percent of total billed charges"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and im ","code_information":[{"code":"37192","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and im ","code_information":[{"code":"37192","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"REPOSITIONING OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; SENSING LEAD ONLY ","code_information":[{"code":"0433T","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":10382.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular lead) ","code_information":[{"code":"0415T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular lead) ","code_information":[{"code":"0415T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Repositioning of previously placed central venous catheter under fluoroscopic guidance ","code_information":[{"code":"36597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":37437.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Reproductive medicine, RNA gene expression profile 238 genes by next-generation sequencing, endometrial tissue, predictive algorithm reported as endometrial window of implantation ","code_information":[{"code":"0253U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3001.45,"maximum":4739.13,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3254.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":3348.99,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4739.13,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":3791.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":3949.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3475.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":3538.55,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3127.83,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3127.83,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3791.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3759.71,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":3317.39,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":3001.45,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":3317.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":3475.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":3317.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":3175.22,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"}]}]},{"description":"Reprogramming of programmable cerebrospinal shunt ","code_information":[{"code":"360","type":"RC"},{"code":"62252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Ethmoidectomy; intranasal, total ","code_information":[{"code":"31201","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral ","code_information":[{"code":"0207T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"EVAL OT LOW COMPLEX ","code_information":[{"code":"792703","type":"CDM"},{"code":"97165","type":"CPT"}],"standard_charges":[{"modifiers":"GO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care","setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1185.00,"discounted_cash":1185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":213.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":296.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":260.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":154.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":177.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":261.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":235.81,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":948.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":189.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":272.55,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":248.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":402.90,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":272.55,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":201.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1007.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":888.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":110.20,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":154.05,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":948.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1007.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":159.97,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1718.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":337.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":533.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":299.81,"methodology":"percent of total billed charges"}]}]},{"description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention ","code_information":[{"code":"369","type":"RC"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21936.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention ","code_information":[{"code":"499","type":"RC"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21936.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 ºPAMG-1», placental protein 12 ºPP12», alpha-fetoprotein), qualitative, each specimen ","code_information":[{"code":"84112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.20,"maximum":147.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":101.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":104.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":147.16,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":117.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":100.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":100.07,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":122.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":107.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":104.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":104.98,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":109.88,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":97.13,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":97.13,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":97.68,"methodology":"fee schedule"},{"payer_name":"Ilumed","plan_name":"MCR","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":117.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":103.02,"methodology":"fee schedule"},{"payer_name":"Palm Beach PACE ","plan_name":"MCR","standard_charge_dollar":93.20,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":103.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":107.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":103.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":98.60,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":98.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":98.11,"methodology":"fee schedule"}]}]},{"description":"Evisceration of ocular contents; with implant ","code_information":[{"code":"369","type":"RC"},{"code":"65093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Evisceration of ocular contents; with implant ","code_information":[{"code":"481","type":"RC"},{"code":"65093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Evisceration of ocular contents; without implant ","code_information":[{"code":"65091","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological ","code_information":[{"code":"361","type":"RC"},{"code":"50435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological ","code_information":[{"code":"499","type":"RC"},{"code":"50435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Exchange of intraocular lens ","code_information":[{"code":"361","type":"RC"},{"code":"66986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure) ","code_information":[{"code":"49423","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure) ","code_information":[{"code":"49423","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"361","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"499","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transmastoid ","code_information":[{"code":"490","type":"RC"},{"code":"69552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues ","code_information":[{"code":"42810","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; complex, under bone or cartilage ","code_information":[{"code":"30125","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision exostosis(es), external auditory canal ","code_information":[{"code":"369","type":"RC"},{"code":"69140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision exostosis(es), external auditory canal ","code_information":[{"code":"481","type":"RC"},{"code":"69140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision external ear; partial, simple repair ","code_information":[{"code":"361","type":"RC"},{"code":"69110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod ","code_information":[{"code":"26390","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision inferior turbinate, partial or complete, any method ","code_information":[{"code":"30130","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision inferior turbinate, partial or complete, any method ","code_information":[{"code":"30130","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of Bartholin's gland or cyst ","code_information":[{"code":"361","type":"RC"},{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of Bartholin's gland or cyst ","code_information":[{"code":"499","type":"RC"},{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of mandible, by enucleation and/or curettage ","code_information":[{"code":"21040","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesionºs») ","code_information":[{"code":"21046","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage ","code_information":[{"code":"21030","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage ","code_information":[{"code":"21030","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesionºs») ","code_information":[{"code":"21049","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed ","code_information":[{"code":"27066","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed ","code_information":[{"code":"27066","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed ","code_information":[{"code":"27065","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed ","code_information":[{"code":"27065","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addi ","code_information":[{"code":"19126","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion ","code_information":[{"code":"19125","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of bulbourethral gland (Cowper's gland) ","code_information":[{"code":"360","type":"RC"},{"code":"53250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of bulbourethral gland (Cowper's gland) ","code_information":[{"code":"499","type":"RC"},{"code":"53250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair ","code_information":[{"code":"360","type":"RC"},{"code":"57555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair ","code_information":[{"code":"499","type":"RC"},{"code":"57555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with repair of enterocele ","code_information":[{"code":"57556","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with repair of enterocele ","code_information":[{"code":"57556","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; multiple, same lid ","code_information":[{"code":"369","type":"RC"},{"code":"67801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; multiple, same lid ","code_information":[{"code":"499","type":"RC"},{"code":"67801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; single ","code_information":[{"code":"360","type":"RC"},{"code":"67800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; single ","code_information":[{"code":"499","type":"RC"},{"code":"67800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"EXCISION OF CHEST WALL TUMOR INCLUDING RIBS ","code_information":[{"code":"19260","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"EXCISION OF CHEST WALL TUMOR INCLUDING RIBS ","code_information":[{"code":"19260","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"EXCISION OF CHEST WALL TUMOR INCLUDING RIBS ","code_information":[{"code":"19260","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst or adenoma of thyroid, or transection of isthmus ","code_information":[{"code":"361","type":"RC"},{"code":"60200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst or adenoma of thyroid, or transection of isthmus ","code_information":[{"code":"499","type":"RC"},{"code":"60200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions ","code_information":[{"code":"19120","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod ","code_information":[{"code":"26415","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of extraparenchymal lesion of testis ","code_information":[{"code":"360","type":"RC"},{"code":"54512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of extraparenchymal lesion of testis ","code_information":[{"code":"499","type":"RC"},{"code":"54512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of fibrous tuberosities, dentoalveolar structures ","code_information":[{"code":"360","type":"RC"},{"code":"41822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); primary ","code_information":[{"code":"25111","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); primary ","code_information":[{"code":"25111","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); primary ","code_information":[{"code":"25111","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); primary ","code_information":[{"code":"25111","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); recurrent ","code_information":[{"code":"25112","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of hyperplastic alveolar mucosa, each quadrant (specify) ","code_information":[{"code":"360","type":"RC"},{"code":"41828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of infected graft; extremity ","code_information":[{"code":"35903","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of infected graft; extremity ","code_information":[{"code":"35903","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; total ","code_information":[{"code":"361","type":"RC"},{"code":"68500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of lactiferous duct fistula ","code_information":[{"code":"19112","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure ","code_information":[{"code":"67840","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee ","code_information":[{"code":"27347","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee ","code_information":[{"code":"27347","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle ","code_information":[{"code":"40816","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle ","code_information":[{"code":"40816","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair ","code_information":[{"code":"360","type":"RC"},{"code":"40814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair ","code_information":[{"code":"40814","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair ","code_information":[{"code":"361","type":"RC"},{"code":"40810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair ","code_information":[{"code":"40810","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of spermatic cord (separate procedure) ","code_information":[{"code":"55520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of spermatic cord (separate procedure) ","code_information":[{"code":"55520","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle ","code_information":[{"code":"27630","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle ","code_information":[{"code":"27630","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle ","code_information":[{"code":"27630","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; anterior two-thirds ","code_information":[{"code":"360","type":"RC"},{"code":"41112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; posterior one-third ","code_information":[{"code":"361","type":"RC"},{"code":"41113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; with local tongue flap ","code_information":[{"code":"41114","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; with local tongue flap ","code_information":[{"code":"41114","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; with local tongue flap ","code_information":[{"code":"41114","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue without closure ","code_information":[{"code":"361","type":"RC"},{"code":"41110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue without closure ","code_information":[{"code":"41110","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair ","code_information":[{"code":"360","type":"RC"},{"code":"41825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, conjunctiva; over 1 cm ","code_information":[{"code":"360","type":"RC"},{"code":"68115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium ","code_information":[{"code":"361","type":"RC"},{"code":"65400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot ","code_information":[{"code":"28090","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each ","code_information":[{"code":"28092","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lingual frenum (frenectomy) ","code_information":[{"code":"41115","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) ","code_information":[{"code":"40527","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) ","code_information":[{"code":"40527","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) ","code_information":[{"code":"40525","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; V-excision with primary direct linear closure ","code_information":[{"code":"40520","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of malignant tumor of maxilla or zygoma ","code_information":[{"code":"21034","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of malignant tumor of maxilla or zygoma ","code_information":[{"code":"21034","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of maxillary torus palatinus ","code_information":[{"code":"21032","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of multiple external papillae or tags, anus ","code_information":[{"code":"369","type":"RC"},{"code":"46230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of multiple external papillae or tags, anus ","code_information":[{"code":"46230","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal ","code_information":[{"code":"11750","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Excision of neurofibroma or neurolemmoma; extensive (including malignant type) ","code_information":[{"code":"64792","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of neuroma; cutaneous nerve, surgically identifiable ","code_information":[{"code":"360","type":"RC"},{"code":"64774","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of neuroma; digital nerve, 1 or both, same digit ","code_information":[{"code":"360","type":"RC"},{"code":"64776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of neuroma; digital nerve, 1 or both, same digit ","code_information":[{"code":"499","type":"RC"},{"code":"64776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of osseous tuberosities, dentoalveolar structures ","code_information":[{"code":"360","type":"RC"},{"code":"41823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection ","code_information":[{"code":"42410","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of penile plaque (Peyronie disease); ","code_information":[{"code":"54110","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of penile plaque (Peyronie disease); ","code_information":[{"code":"54110","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of pilonidal cyst or sinus; complicated ","code_information":[{"code":"11772","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of pilonidal cyst or sinus; extensive ","code_information":[{"code":"11771","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of pilonidal cyst or sinus; extensive ","code_information":[{"code":"11771","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of pilonidal cyst or sinus; simple ","code_information":[{"code":"11770","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of pilonidal cyst or sinus; simple ","code_information":[{"code":"11770","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach ","code_information":[{"code":"45160","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of rectal tumor, transanal approach; not including muscularis propria (ie, partial thickness) ","code_information":[{"code":"369","type":"RC"},{"code":"45171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of rectal tumor, transanal approach; not including muscularis propria (ie, partial thickness) ","code_information":[{"code":"45171","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of single external papilla or tag, anus ","code_information":[{"code":"46220","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of single external papilla or tag, anus ","code_information":[{"code":"46220","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair ","code_information":[{"code":"11463","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair ","code_information":[{"code":"11462","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair ","code_information":[{"code":"11462","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair ","code_information":[{"code":"11471","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair ","code_information":[{"code":"11470","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repair ","code_information":[{"code":"11470","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of spermatocele, with or without epididymectomy ","code_information":[{"code":"369","type":"RC"},{"code":"54840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of spermatocele, with or without epididymectomy ","code_information":[{"code":"481","type":"RC"},{"code":"54840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of sublingual gland ","code_information":[{"code":"369","type":"RC"},{"code":"42450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of sublingual gland ","code_information":[{"code":"42450","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of submandibular (submaxillary) gland ","code_information":[{"code":"42440","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22329.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15968.00,"methodology":"case rate"}]}]},{"description":"Excision of synovial cyst of popliteal space (eg, Baker's cyst) ","code_information":[{"code":"27345","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of synovial cyst of popliteal space (eg, Baker's cyst) ","code_information":[{"code":"27345","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of tendon, finger, flexor or extensor, each tendon ","code_information":[{"code":"26180","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of tendon, palm, flexor or extensor, single, each tendon ","code_information":[{"code":"26170","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of tendon, palm, flexor or extensor, single, each tendon ","code_information":[{"code":"26170","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of tendon, palm, flexor or extensor, single, each tendon ","code_information":[{"code":"26170","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of thrombosed hemorrhoid, external ","code_information":[{"code":"46320","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision of thyroglossal duct cyst or sinus; ","code_information":[{"code":"499","type":"RC"},{"code":"60280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7915.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision of thyroglossal duct cyst or sinus; recurrent ","code_information":[{"code":"360","type":"RC"},{"code":"60281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision of urachal cyst or sinus, with or without umbilical hernia repair ","code_information":[{"code":"51500","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of urachal cyst or sinus, with or without umbilical hernia repair ","code_information":[{"code":"51500","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of urethral diverticulum (separate procedure); female ","code_information":[{"code":"490","type":"RC"},{"code":"53230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of vaginal cyst or tumor ","code_information":[{"code":"57135","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of vaginal cyst or tumor ","code_information":[{"code":"57135","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of varicocele or ligation of spermatic veins for varicocele; (separate procedure) ","code_information":[{"code":"55530","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach ","code_information":[{"code":"369","type":"RC"},{"code":"55535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach ","code_information":[{"code":"481","type":"RC"},{"code":"55535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach ","code_information":[{"code":"490","type":"RC"},{"code":"55535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; ","code_information":[{"code":"23140","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft) ","code_information":[{"code":"23145","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; ","code_information":[{"code":"27355","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; with allograft ","code_information":[{"code":"27356","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; with allograft ","code_information":[{"code":"27356","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; with allograft ","code_information":[{"code":"27356","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10868.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft) ","code_information":[{"code":"27357","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft) ","code_information":[{"code":"27357","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft) ","code_information":[{"code":"24125","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft) ","code_information":[{"code":"24125","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of metacarpal; ","code_information":[{"code":"26200","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of metacarpal; ","code_information":[{"code":"26200","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft) ","code_information":[{"code":"26205","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft) ","code_information":[{"code":"26205","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft ","code_information":[{"code":"23156","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograft ","code_information":[{"code":"23156","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft) ","code_information":[{"code":"23155","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft) ","code_information":[{"code":"23155","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; ","code_information":[{"code":"26210","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; ","code_information":[{"code":"26210","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; ","code_information":[{"code":"26210","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; ","code_information":[{"code":"26210","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft) ","code_information":[{"code":"26215","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft) ","code_information":[{"code":"26215","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft ","code_information":[{"code":"25126","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft) ","code_information":[{"code":"25125","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft) ","code_information":[{"code":"25125","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, humerus; with allograft ","code_information":[{"code":"24116","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft) ","code_information":[{"code":"24115","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, phalanges of foot ","code_information":[{"code":"28108","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, phalanges of foot ","code_information":[{"code":"28108","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, talus or calcaneus; ","code_information":[{"code":"28100","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; ","code_information":[{"code":"28104","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft ","code_information":[{"code":"28107","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft (includes obtaining graft) ","code_information":[{"code":"28106","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft) ","code_information":[{"code":"27637","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy) ","code_information":[{"code":"30118","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction (eg, laser), intranasal lesion; internal approach ","code_information":[{"code":"30117","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction (eg, laser), intranasal lesion; internal approach ","code_information":[{"code":"30117","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction (eg, laser), intranasal lesion; internal approach ","code_information":[{"code":"30117","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction lingual tonsil, any method (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"42870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction lingual tonsil, any method (separate procedure) ","code_information":[{"code":"42870","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5.1-10.0 cm diameter ","code_information":[{"code":"360","type":"RC"},{"code":"49204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor greater than 10.0 cm diam ","code_information":[{"code":"49205","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14492.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Excision or fulguration of carcinoma of urethra ","code_information":[{"code":"481","type":"RC"},{"code":"53220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Excision or fulguration; Skene's glands ","code_information":[{"code":"360","type":"RC"},{"code":"53270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or fulguration; urethral prolapse ","code_information":[{"code":"481","type":"RC"},{"code":"53275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or fulguration; urethral prolapse ","code_information":[{"code":"490","type":"RC"},{"code":"53275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or fulguration; urethral prolapse ","code_information":[{"code":"53275","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or transposition of pterygium; with graft ","code_information":[{"code":"369","type":"RC"},{"code":"65426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or transposition of pterygium; with graft ","code_information":[{"code":"481","type":"RC"},{"code":"65426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or transposition of pterygium; with graft ","code_information":[{"code":"490","type":"RC"},{"code":"65426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or transposition of pterygium; with graft ","code_information":[{"code":"65426","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision or transposition of pterygium; without graft ","code_information":[{"code":"361","type":"RC"},{"code":"65420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Excision soft tissue lesion, external auditory canal ","code_information":[{"code":"360","type":"RC"},{"code":"69145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less ","code_information":[{"code":"11420","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm ","code_information":[{"code":"11421","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm ","code_information":[{"code":"11422","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11424","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less ","code_information":[{"code":"11400","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less ","code_information":[{"code":"11400","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less ","code_information":[{"code":"11400","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less ","code_information":[{"code":"11400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm ","code_information":[{"code":"11403","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11404","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture ","code_information":[{"code":"15920","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of permanent cardiac contractility modulation system pulse generator only ","code_information":[{"code":"0414T","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":76506.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":76506.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":53616.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of permanent cardiac contractility modulation system pulse generator only ","code_information":[{"code":"0414T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":76506.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":76506.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":53616.00,"methodology":"case rate"}]}]},{"description":"Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia) ","code_information":[{"code":"21029","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia) ","code_information":[{"code":"21029","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"360","type":"RC"},{"code":"54115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"499","type":"RC"},{"code":"54115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; without general anesthesia ","code_information":[{"code":"361","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; without general anesthesia ","code_information":[{"code":"499","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; by lateral rhinotomy ","code_information":[{"code":"30320","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; office type procedure ","code_information":[{"code":"30300","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; requiring general anesthesia ","code_information":[{"code":"30310","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; requiring general anesthesia ","code_information":[{"code":"30310","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; requiring general anesthesia ","code_information":[{"code":"30310","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; requiring general anesthesia ","code_information":[{"code":"30310","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal impacted cerumen requiring instrumentation, unilateral ","code_information":[{"code":"369","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal impacted cerumen requiring instrumentation, unilateral ","code_information":[{"code":"481","type":"RC"},{"code":"69210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER ","code_information":[{"code":"33284","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER ","code_information":[{"code":"33284","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"Removal of ankle implant ","code_information":[{"code":"27704","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4757.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of ankle implant ","code_information":[{"code":"27704","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidan ","code_information":[{"code":"47537","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of blood clot, anterior segment of eye ","code_information":[{"code":"361","type":"RC"},{"code":"65930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of blood clot, anterior segment of eye ","code_information":[{"code":"499","type":"RC"},{"code":"65930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of cerclage suture under anesthesia (other than local) ","code_information":[{"code":"59871","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of cerclage suture under anesthesia (other than local) ","code_information":[{"code":"59871","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ","code_information":[{"code":"361","type":"RC"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ","code_information":[{"code":"499","type":"RC"},{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body from dentoalveolar structures; soft tissues ","code_information":[{"code":"361","type":"RC"},{"code":"41805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body from dentoalveolar structures; soft tissues ","code_information":[{"code":"41805","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, eyelid ","code_information":[{"code":"369","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, eyelid ","code_information":[{"code":"481","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, eyelid ","code_information":[{"code":"490","type":"RC"},{"code":"67938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, vestibule of mouth; complicated ","code_information":[{"code":"40805","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":9498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, vestibule of mouth; simple ","code_information":[{"code":"369","type":"RC"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, vestibule of mouth; simple ","code_information":[{"code":"40804","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of esophageal sphincter augmentation device ","code_information":[{"code":"43285","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Removal of esophageal sphincter augmentation device ","code_information":[{"code":"43285","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Removal of esophageal sphincter augmentation device ","code_information":[{"code":"43285","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":22734.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22734.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":16083.00,"methodology":"case rate"}]}]},{"description":"Removal of fecal impaction or foreign body (separate procedure) under anesthesia ","code_information":[{"code":"361","type":"RC"},{"code":"45915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of fecal impaction or foreign body (separate procedure) under anesthesia ","code_information":[{"code":"45915","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body from pharynx ","code_information":[{"code":"42809","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body from pharynx ","code_information":[{"code":"42809","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body from pharynx ","code_information":[{"code":"42809","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in muscle or tendon sheath; simple ","code_information":[{"code":"20520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in muscle or tendon sheath; simple ","code_information":[{"code":"20520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in muscle or tendon sheath; simple ","code_information":[{"code":"20520","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in scrotum ","code_information":[{"code":"361","type":"RC"},{"code":"55120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body in scrotum ","code_information":[{"code":"499","type":"RC"},{"code":"55120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of stomach, by laparotomy ","code_information":[{"code":"369","type":"RC"},{"code":"43605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, incisional (separate procedure) ","code_information":[{"code":"54505","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4757.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, needle (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"54500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, needle (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"54500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of tongue; anterior two-thirds ","code_information":[{"code":"369","type":"RC"},{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy of tongue; posterior one-third ","code_information":[{"code":"41105","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy of urethra ","code_information":[{"code":"360","type":"RC"},{"code":"53200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; simple (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"57100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); 1 lesion ","code_information":[{"code":"361","type":"RC"},{"code":"56605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"56606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep axillary node(s) ","code_information":[{"code":"38525","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) ","code_information":[{"code":"360","type":"RC"},{"code":"38510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"360","type":"RC"},{"code":"38520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, superficial ","code_information":[{"code":"360","type":"RC"},{"code":"38500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, superficial ","code_information":[{"code":"38500","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft) ","code_information":[{"code":"20245","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx) ","code_information":[{"code":"20240","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) ","code_information":[{"code":"20225","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) ","code_information":[{"code":"20225","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) ","code_information":[{"code":"20220","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19082","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5498.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2772.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5498.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3933.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including s ","code_information":[{"code":"19081","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including u ","code_information":[{"code":"19083","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, intranasal ","code_information":[{"code":"30100","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, intranasal ","code_information":[{"code":"30100","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, intranasal ","code_information":[{"code":"30100","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE ","code_information":[{"code":"32405","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":5708.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle; superficial ","code_information":[{"code":"20200","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"360","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; needle or punch, single or multiple, any approach ","code_information":[{"code":"499","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; superficial ","code_information":[{"code":"25065","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of neck or thorax ","code_information":[{"code":"21550","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular ","code_information":[{"code":"27041","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; superficial ","code_information":[{"code":"27040","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; deep ","code_information":[{"code":"23066","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; superficial ","code_information":[{"code":"23065","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; superficial ","code_information":[{"code":"23065","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) ","code_information":[{"code":"27324","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) ","code_information":[{"code":"27324","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; superficial ","code_information":[{"code":"27323","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular) ","code_information":[{"code":"24066","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; superficial ","code_information":[{"code":"24065","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2310.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; lumbar or cervical ","code_information":[{"code":"20251","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; thoracic ","code_information":[{"code":"20250","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; thoracic ","code_information":[{"code":"20250","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":19323.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10382.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19323.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13818.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, survey for unknown primary lesion ","code_information":[{"code":"369","type":"RC"},{"code":"42806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":17666.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9498.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17666.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12632.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, visible lesion, simple ","code_information":[{"code":"369","type":"RC"},{"code":"42804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2625.00,"maximum":8158.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":5708.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2625.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8158.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5837.00,"methodology":"case rate"}]}]},{"description":"Biopsy; oropharynx ","code_information":[{"code":"42800","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7327.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2310.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7327.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5239.00,"methodology":"case rate"}]}]},{"description":"BIT DRILL 1.1MM ","code_information":[{"code":"843070","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1030.00,"discounted_cash":1030.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":169.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":77.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":196.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":148.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":185.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":257.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":226.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":133.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":85.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":74.16,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":154.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":227.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":204.97,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":824.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":164.80,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":236.90,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":350.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":236.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":175.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":875.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":772.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":95.79,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":133.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":824.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":875.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":515.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":139.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1493.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":293.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":463.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":260.59,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.6MM 2.4MM ","code_information":[{"code":"896494","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.9MM 2.5MM ","code_information":[{"code":"920317","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.5MM ","code_information":[{"code":"933227","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":5006.00,"discounted_cash":5006.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":825.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":375.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":956.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":720.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":901.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1251.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1101.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":360.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":750.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1106.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":996.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":800.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1051.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1702.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1151.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3754.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":465.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":650.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4004.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4255.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2503.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":675.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7258.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1426.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2252.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1266.52,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.5MM 257MM ","code_information":[{"code":"928495","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.6MM SM CB ","code_information":[{"code":"872368","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.9MM ","code_information":[{"code":"865274","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 3.2MM ","code_information":[{"code":"911519","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 3.5MM ","code_information":[{"code":"800866","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4.0MM ","code_information":[{"code":"808713","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":1834.00,"discounted_cash":1834.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":302.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":137.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":350.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":264.10,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":330.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":458.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":403.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":238.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":152.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":132.05,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":275.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":405.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":364.97,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1467.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":293.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":421.82,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":385.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":623.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":421.82,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":311.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1558.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1375.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":170.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":238.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1467.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1558.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":917.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":247.59,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2659.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":522.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":825.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":464.00,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4.3MM CANN 6.5 ","code_information":[{"code":"897217","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4.5MM 120MM ","code_information":[{"code":"937539","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL AO QC 3MM ","code_information":[{"code":"934858","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL CANN 2.2X60MM ","code_information":[{"code":"911979","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2407.00,"discounted_cash":2407.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":397.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":180.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":459.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":346.61,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":433.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":601.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":529.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":312.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":199.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":173.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":361.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":531.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":478.99,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1925.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":385.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":553.61,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":505.47,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":818.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":553.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":409.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2045.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1805.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":223.85,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":312.91,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1925.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2045.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1203.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":324.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3490.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":686.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1083.15,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":608.97,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL CANN 2.7MM ","code_information":[{"code":"923950","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":3646.00,"discounted_cash":3646.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":601.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":273.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":696.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":525.02,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":656.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":911.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":802.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":473.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":302.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":262.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":546.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":805.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":725.55,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2916.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":583.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":838.58,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":765.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1239.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":838.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":619.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3099.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2734.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":339.08,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":473.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2916.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3099.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1823.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":492.21,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5286.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1039.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1640.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":922.44,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL CANN 3.6MM ","code_information":[{"code":"936095","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":353.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":752.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":508.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":376.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1659.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":205.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1769.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1880.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":298.62,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3207.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":630.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":995.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":559.64,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL DISP 2.5MM ","code_information":[{"code":"842121","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2944.00,"discounted_cash":2944.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":485.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":220.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":562.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":423.94,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":529.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":736.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":647.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":244.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":211.97,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":441.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":650.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":585.86,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2355.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":471.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":677.12,"methodology":"percent of total billed charges"},{"payer_name":"Healthy Palm Beaches","plan_name":"COMM","standard_charge_dollar":550.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":618.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1000.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":677.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges not to exceed $3000.","estimated_amount":500.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2502.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2208.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":273.79,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":382.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2355.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2502.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":397.44,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4268.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":839.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1324.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":744.83,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL DISP 2.8MM 45M ","code_information":[{"code":"918659","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":550.00,"maximum":550.00,"gross_charge":2212.00,"discounted_cash":2212.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":364.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":165.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":422.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":318.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":398.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":553.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":486.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":287.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":464.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":8.30,"standard_charge_algorithm":"Reimbursement will be 8.3% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.20,"standard_charge_algorithm":"Reimbursement will be 7.2% of billable gross charges.","estimated_amount":159.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":331.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":488.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":440.19,"methodology":"percent of total billed charges"},{"payer_name":"District Cares","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1106.00,"methodology":"percent of total billed charges"},{"pa